IJCRR - Vol 07 Issue 19, October, 2015
SALBUTAMOL NEBULISATION: IS IT A PREDISPOSING FACTOR FOR POSTOPERATIVE ATRIAL FIBRILLATION IN CORONARY ARTERY BYPASS GRAFTING PATIENTS?
Author: Megha Shah, Hetal D. Shah
Background: Atrial fibrillation (AF) is one of the known complications of cardiac surgery and represents a major cause of morbidity. However, improvements in surgical and anaesthesia technique and controlling various predisposing factors have not helped to curb the incidence. Therefore, search is going on for various modalities to decrease the incidence.
Aim: This retrospective study was conducted to evaluate the risk of AF with nebulised ß2 agonists in postoperative cardiac bypass surgery patients.
Methods: In this observational study, data of 100 eligible patients operated for coronary artery bypass grafting (CABG) was collected. Patients were divided in two groups: Group A: Patients who had received postoperative nebulised salbutamol Group B: Patients who had not received postoperative nebulised salbutamol The data was analyzed for onset, duration, severity, treatment, outcome of post operative AF (POAF) and also regarding dose, duration of salbutamol.
Results: POAF occurred frequently in patients who had received nebulised salbutamol (p<0.05). ICU and hospital stay was also prolonged in Group A. However, none of the patients had fatal postoperative complication.
Conclusion: Salbutamol nebulisation in post CABG patients could be an additional risk factor for POAF.
Keywords: Atrial fibrillation, ß2 agonists, Post cardiac surgery patients, Salbutamol nebulisation
Megha Shah, Hetal D. Shah. SALBUTAMOL NEBULISATION: IS IT A PREDISPOSING FACTOR FOR POSTOPERATIVE ATRIAL FIBRILLATION IN CORONARY ARTERY BYPASS GRAFTING PATIENTS? International Journal of Current Research and Review. Vol 07 Issue 19, October, 16-19
1. Hashimoto, Hsturp. Influence of clinical and hemodynamic variables on risk of supraventricular tachycardia after CABG. J Thorac Cardiovascular Surg. 1993; 56: 405.
2. Ma JP, Fontes ML, Tudor IC, et al. A multicenter risk index for atrial fibrillation after cardiac surgery. JAMA. 2004; 291:1720- 9.
3. Chidambaram M, Akhtar MJ, Al-Nozha M, Saddique A. A relationship of atrial fibrillation to significant pericardial effusion in valve replacement patients. Thorac Cardiovascular Surg. 1992; 10 :70 -3.
4. Dimpi Patel, Marc A Gillinov, Andrea Natale. Atrial Fibrillation after Cardiac Surgery: Where are we now? Indian Pacing and Electrophysiology Journal. 2008; 8 (4): 281-91.
5. Steve ommen, John A. Odel, Marshall S. Stanton. Atrial arrhythmias after cardiothoracic surgery. NEJM. 1997; 336(20): 1429-34.
6. Salpeter SR, Ormiston TM, Salpeter EE. Cardiovascular effects of beta-agonists in patients with asthma and COPD: a meta-analysis. Chest. 2004; 125: 2309–21.
7. Au DH, Lemaitre RN, Curtis JR, Smith NL, Psaty BM. The risk of myocardial infarction associated with inhaled beta-adrenoceptor agonists. American journal of respire criti care med. 2000;161: 827-30.
8. Cazzola M, Matera MG, Donner CF. Inhaled beta 2-adrenoceptor agonists: cardiovascular safety in patients with obstructive lung disease. Drugs. 2005; 65(12):1595-610.
9. Appleton S, Poole P, Smith B, Veale A, Lasserson T, Chan M.
structive pulmonary disease. Cochrane Database Syst Rev. 2006;3:CD001104.
10. Salpeter SR, Buckley NS, Salpeter EE. Meta-analysis: anticholinergics, but not beta-agonists, reduce severe exacerbations and respiratory mortality in COPD. J Gen Intern Med. 2006; 21:1011-9.
11. Maisel WH, Rawn JD, Stevenson W. Atrial fibrillation after cardiac surgery. Ann Intern Med. 2001;135;1061-73.
12. B J Lipworth .Revisiting interactions between hypoxaemia and ß2 agonists in asthma. Thorax. 2001; 56 :567-9.
13. Carlos A. Viegas, Antoni Ferrer, Josep M. Montserrat, Joan A. Barbera, Josep Roca, Robert Rodriguez-Roisin. Ventilationperfusion response after fenoterol in hypoxemic patients with stable COPD. Lancet. 1990; 336 :1396-99.
14. Breeden C, Safirstein B. Albuterol and spacer induced atrial fibrillation. Chest. 1990; 98:762-3.
15. Crystal E, Connolly S, Sleik K et al. Interventions on prevention of postoperative atrial fibrillation in patients undergoing heart surgery: A meta- analysis. Circulation. 2002; 106:75-80.
16. Anderson PJ, Zhou X, Breen P, Gann L, Logsdon TW, Compadre CM, et al. Pharmacokinetics of (R,S)-Albuterol after aerosol inhalation in healthy adult volunteers. J Pharm Sci. 1998; 87: 841–4.