Comparison of perioperative complications in asthmatics pretreated with or without aminophylline

Lee, Sang Pyo; Lim, Young Hee; Lee, Byung Jae; Choi, Dong Chull

Abstract

BACKGROUND: Patients with bronchial asthma are thought to be at higher risk for pulmonary complications during the perioperative period, and these complications may lead to serious morbidity. But the world-wide guideline for the adequate perioperative management of asthmatics has not yet been established.
OBJECTIVE
The purpose of this study was to determine the effect of perioperative amino- phylline coadministration in asthmatics pretreated with systemic glucocorticoid before and after surgery.
METHODS
Forty-one patients with bronchial asthma admitted for surgical procedures under general anesthesia were included. They were divided into two groups: group I (21 patients, perioperative management with steroid alone) and group II (17 patients, perioperative mana- gement with steroid and aminophylline). Selection of the patients was made from an allocation list based on the patient's admission number to the program. Spirometry was performed before, 24 hr and 48 hr after operation. EKG, pulse oxymetry and/or arterial blood gas analysis, and serum electrolytes were checked before and 24 hr after operation. Chest x-ray was obtained before and 48 hr after operation.
RESULTS
FEV1 was decreased after operation, but there was no significant difference between the two groups. Oxygen saturation in pulse oxymetry and/or arterial oxygen were not signifi- cantly decreased during the perioperative period. In group I, two patients had intraoperative bron- chospasm and one patient had postoperative asthmatic attack. In group II, two patients had intraoperative bronchospasm, one patient had multifocal ventricular arrhythmia. Pneumothorax, pneumonia, and other complications were not noted.
CONCLUSION
These results suggest that most persons with asthma can safely undergo generalanesthesia with perioperative steroid administration. Presuming adequate preoperative assessment and preparation, additional aminophylline preparations before surgery may not be preferable.