The efficacy of postoperative bronchodilator usage

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The efficacy of postoperative bronchodilator
usage

• Ri ???

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The effect of nebulized salbutamol therapy on the
incidence of postoperative chest infection on
high risk patients

• Dilworth JP, Warley AR, Dawe C, White
  RJ.Department of Medicine, Frenchay Hospital,
  Bristol, U.K.
• Respiratory Medicine. 1994 Oct88(9)665-8.

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Introduction

• Postoperative respiratory complication
  respiratory infection
• High risk chronic airway obstruction, recurrent
  bronchitis, heavy smokers
• Previous trials prophylactic antibiotics,
  various physiotherapy technique, regional
  anaesthetic techniques
• The study was designed to determine whether
  perioperative high dose salbutamol therapy in
  high risk patients reduced the risk of
  postoperative respiratory track infection

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Methods

• Frenchay Hospital, July 1989 to July 1991,
  patients for surgery requiring an anterior
  abdominal incision
• Respiratory questionnaire and spirometric
  measurement
• Patients eligible for inclusion chronic
  bronchitisairflow obstruction
  FEV1/FVClt70current or previous smokers at
  least 20 pack years

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• Randomized double-blind protocol was followed
• Group A 5 mg neubulized salbutamol at 6 hourly
  interval from 1h preoperatively for a total of
  48h( 8 doses)
• Group B 5ml nebulized normal saline

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• Patients were seen on alternate days during the
  postoperative period and the presence of fever,
  cough, purulent sputum and new chest signs.
• CXR and blood white count preoperative and the
  second postoperative day
• Respiratory infection purulent sputum and one
  out of pyrexia, cough, new chest signs,
  radiographic change or leukocytosis

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Results

• No major difference between the two groups
• Overall incidence of respiratory tract infection
  40
• Analysis of subgroups no any significant
  difference in smokers, chronic bronchitis or
  those with airflow obstruction alone

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Discussion

• The dominant finding in those at high risk
  airflow obstruction and excess mucus production
• Salbutamol bronchodilator action, improving
  mucociliary clearance, may resulted in a useful
  reduction in the incidence of postoperative
  infection
• No such result was obtained.

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• Patients had baseline spirometry prior to surgery
• Serial measurement of ventilatory function was
  not made due to abdominal wounds in the immediate
  postoperative time
• It cannot be stated that whether these patients
  exhibited any reversibility in airflow
  obstruction

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• This study has provided no support for the
  routine use of high dose bronchodilator therapy
  as a prophylactic measure against postoperative
  respiratory infection in high risk patients

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Terbutaline improves efficiency of oxygenation
after coronary artery bypass surgery.

• Waller DA, Saunders NR.Department of
  Cardiothoracic Surgery, Killingbeck Hospital,
  Leeds, UK.
• J Cardiovasc Surg (Torino). 1996 Feb37(1)59-62

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• Post-CABG respiration complications sputum
  retention, atelectasis, and hypoxia
• Median sternotomy and internal thoracic artery
  dissection restrictive ventilatory defect
• Complement and neutrophil mediated injury
  secondary to extra-corporeal circulation lung
  interstitial edema

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• To assess the therapeutic role of the
  beta-receptor agonist terbutaline in reducing
  postoperative pulmonary dysfunction following
  coronary artery bypass grafting

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Methods

• 22 patients undergoing CABG were randomized into
  two groups
• Group C no additional treatment
• Group T subcutaneous terbutaline 0.5 mg 6 hourly
  for the first 48 hours after extubation
• Subcutaneous route avoid the uncertainty of
  delivery from aerosol, and acute cardiovascular
  side effects form iv administration

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• Baseline spirometry peak expiratory flow rate
  (PEFR), FEV1, FVC
• Exclusion criteria asthma, current use of
  bronchodilators, DM or prolonged assisted
  ventilation in excess of 36 hrs

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• Postoperative measurement ABG, PEFR, FEV1, FVC,
  continuous invasive arterial blood pressure,
  continuous ECG
• Analysis alveolar-arterial oxygen difference
  (A-aDO2) and PaO2FiO2 reflecting the degree of
  physiological shunt

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Results
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• CABG resulted in a significant reduction in FVC,
  FEV1 and PEFR in both groups, no significant
  difference.
• Significant increase from the immediate
  post-extubation in both groups
• FEV1 FVC ratio was unaffected by CABG

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• Alveolar-arterial oxygen difference increase
  significantly after extubation in both groups and
  remained significantly elevated for the next
  18hrs in group C
• At 6 hrs post-extubation, there was no
  significant difference in A-aDO2 from
  pre-extubation values (P0.069)

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• The results show no improvement in spirometric
  parameter
• Improvement in oxygenation stimulatory effects
  on mucociliary clearance , preventing small
  airways closure, or due to increased pulmonary
  blood flow
• Little therapeutic role for the terbutaline as a
  bronchodilator in reducing respiratory
  insufficiency after CABG

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• Routine use of high dose bronchodilator therapy
  as a prophylactic measure against postoperative
  respiratory infection in high risk patients not
  supported
• Little therapeutic role for the terbutaline as a
  bronchodilator in reducing respiratory
  insufficiency after CABG