[HSF] cordarone toxicity

[M. A. Quader, MD]

Dear Dr. Vasu,
I have read about amiodorone induced pulmonary toxicity and have seen one in my
experience. It is very intense when happens and not much you could do about it. The
literature says that amio binds to pulmonary alveoli and once it comes in contact
with high oxygen concentration (during induction of anesthesia) it sets up an
intense inflammatory reaction.  It seems to affect patients who are on amio for long
term before surgery and develop ARDS like pic immediately after surgery. The first
or second day chest x-ray is completely white! Since the half-life of amio is in
weeks (50days) there is not much to be gained by stopping it before the surgery. One
suggestion mentioned is to use prophylactic steroids before the induction of
anesthesia and continue for a day or so after the surgery. I do this on patients who
are on amio for any reason before the surgery. If the inciting event is acute
inflammation at alveolar level this might justify use of steroids, but hard to
prove.
Of course long pump run and pump related ARDS is well know to incite an event you
described, I strongly believe a role of amio. Unfortunately once the process sets in
you can only provide supportive care.
Think of giving steroids BRFORE induction of anesthesia in patients on long term amio.
Thanks.
Mo


~~~~~~~~~~ M. Andre Vasu~~~~~~~~~~
> A 90 you man viable individual undergoes MV repair,Maze and Lima to Lad.Postop pt
> is stable with excellent cardiac output,ABGs and FIO2 40 percent.The evening of
> surgery he goes into Afib and is started on Cordarone drip.Within two hours he is
> on 100 % O2 in florid respiratory failure.Agreement with family to place SciMed
> oxigenator for 48 hours only.He does not recover and dies. Autopsy shows MV
> repaired Lima patent and lungs congested.
> Acute pulmonary toxicity in ICU setting has been reported but is rare.Pt had prior
> exposure to the drug. Any experience among members and advice as to treatment.
> M.Andre Vasu
> Punta Gorda,Fl
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