The Effects of Endotracheal Administration of N-Acetylcysteine on the Respiratory Functions

Abstract

In this study, to investigate the effect on the per and postoperative respiratory complications of the administration of n-acetyl cystein as endotracheal during intubation to the smoker patients undergoing surgery was aimed. This study was planned as prospective, randomized, placebo controlled, double blinded and 40 patients as two groups. The study included between 20 to 60 years of age, ASA I-II, patients who were satisfied the following conditions; minimum 10 cigarettes per day for minimum 5 years and need to take general anesthesia. Chest radiography, respiratory functions test and arterial blood pressure of the patients were analyzed preoperatively. After intubation, 2 ml % 0,9 NaCl (normal saline) was given to group P (n=20) and 2 ml n-acetyl cystein was given to group N (n=20) via inside the intubation tube and for rapid absorption high pressure ventilation (20cmH2O) was applied several times. ECG, non - invasive arterial pressure, heart beat rate, peripheric arterial oxigen saturation and entidal carbondioxid were monitored. Blood pressure at 1 and 24 hours and respiratory function test and chest radiography at 24 hours were repeated post operative. Pre-operative FEV1/FVC in n-asetilcystein group was found significantly lower than placebo group (p

Keywords

• N-asetylcystein, intratracheal, FEV1/FVC, atelectasy

Endotrakeal N-Asetilsistein Uygulamasının Postoperatif Solunum Fonksiyonlarına Etkisi

Abstract

Bu çalışmada, sigara içen ameliyat olacak hastalarda, entübasyon sırasında intratrakeal n-asetilsistein uygulanmasının per-postoperatif solunumsal komplikasyonlar üzerine etkisinin araştırılması amaçlandı. Çalışma, prospektif, randomize, plasebo kontrollü ve çift kör olarak planlandı. 20–60 yaş aralığındaki, ASA I-II, en az 5 yıldır günde 10 adetten fazla sigara içen ve genel anestezi alacak 40 hasta iki gruba randomize edildi. Hastaların preoperatif akciğer grafisi, solunum fonksiyon testi ve arteriyel kan gazı incelendi. Entübasyon sonrası entübasyon tüpü içerisine plasebo grubuna (n=20) 2 ml % 0,9 NaCl (serum fizyolojik), n-asetilsistein grubuna (n=20) 2 ml n-asetilsistein verilerek ilaçların hızlı emilmesi için birkaç kez yüksek basınçlı (20 cmH2O) ventilasyon uygulandı. EKG, non-invazif arteriyel basınç, kalp atım hızı, SPO2 ve ETCO2 monitörize edildi. Postoperatif 1 ve 24. saat kan gazı ile 24. saat solunum fonksiyon testi ve akciğer grafisi tekrarlandı. Preoperatif FEV1/FVC n-asetilsistein grubunda anlamlı düşük bulundu (p

Keywords

• N-asetilsistein, intratrakeal, FEV1/FVC, atelektazi

References

1. Rocka P, Richb PB. Postoperative pulmonary complications. Curr Opin Anaesthesiol, 16: 123-132, 2003
2. Vodinh J, Bonnet F, Lefloch JP, et al. Risk factors of postoperative pulmonary complications after vascular surgery. Surgery, 105: 360-365, 1989.
3. Fielding LP, Phillips RK, Hittinger R. Factors influencing mortality after curative resection for large bowel cancer in elderly patients. Lancet, 18: 595-597, 1989.
4. Warner DO. Preventing postoperative pulmonary complications. Anesthesiology, 92: 1467-1472, 2000.
5. Brooks-Brunn JA. Predictors of postoperative pulmonary complications following abdominal surgery. Chest, 111: 564-571, 1997.
6. Dales RE, Doinne G, Leech JA, et al. Preoperative prediction of pulmonary complications following thoracic surgery. Chest, 104: 155-159, 1993.
7. Bluman LG, Mosca L, Newman N, et al. Preoperative smoking habits and postoperative pulmonary complications. Chest, 113: 883-889, 1998.
8. Larsson L, Lode H, Rollof J. Use of antibiotics, antioxidants, mucolytics and vaccines in the therapy of chronic obstructive pulmonary disease. Eur Respir Mon, 7: 163-168, 1998.

9. Jayr C, Matthay MA, Goldstone J, et al. Preoperative and intraoperative factors associated with prolonged mechanical 16. Costantini D, Padoan R, Valade A, Guadagni L. ventilation: a study in patients following major abdominal vascular surgery. Chest, 103: 1231- 1236, 1993.
10. Borgstrom L, Kagedal B, Paulsen O. Pharmacokinetics of N-acetylcysteine in man. Eur J Clin Pharmacol, 31: 217-222, 1986.
11. Sciuto AM, Strickland PT, Kennedy TP, Gurtner GH. Protective effects of N- acetylcysteine treatment after phosgene exposure in rabbits. Am J Respir Crit Care Med, 151: 768-72, 1995.
12. Webb WR. Clinical evaluation of new mucolytic agent, acetyl-cysteine. J Thorac Cardiovasc Surg, 44: 330-343, 1962.
13. Rolly G, Cocks F. Use of acetylcysteine in intubated or tracheotomized intensive care patients. Eur J Respir Dis, 61: 75, 1980.
14. Gotz M, Kraemer R, Kerrrebijn KF, Popow C. Oral acetylcysteine in cystic fibrosis. A co- operative study. Eur J Respir Dis, 61: 122-126, 1980.
15. Rao S, Wilson B, Brooks C, Sproule BJ. Acute effects of nebulization of N-acetylcysteine on pulmonary mechanics and gase exchange. Am Rev Respir Dis, 102: 17-22, 1970. Evaluation of the therapeutic effectiveness of thiopronine in children with cystic fibrosis. Curr Ther Res, 31: 714-718, 1982.
16. Davreux CJ, Soric I, Nathens AB, et al. N- acetylcysteine attenuates acute lung injury in the rat. Shock, 8: 432-438. 1997.
17. Donaldson JC, Stop DR, Raymond L, Royall JD, Hippensteel KE, Cobb OM. Acetylcysteine for life-threatening acute bronchial obstruction. Ann Intern Med, 88: 656, 1978.
18. Rogers DF, and Jeffery PK. Inhibition by oral N- acetylcysteine of cigarette smoke-induced “bronchitis” in the rat. Exp. Lung Res, 10: 267- 283, 1986.
19. Izzotti A, Balansky R, Scatolini L, Rovida A, and De Flora S. Inhibition by N-acetylcysteine of carcinogen-DNA adducts in the tracheal epithelium of rats exposed to cigarette smoke. Carcinogenesis, 16: 669-672, 1995.
20. Bibi H, Seifert B, Oullette M, Belik J. Intratracheal N-acetylcysteine use in infants with chronic lung disease. Acta Paediatr, 81: 335-339, 1992. 10