Inotropes

The preoperative assessment of patients for lung resection should identify those with impaired cardiac function. Right ventricular failure is an absolute contraindication to elective resection, given the need for increased right ventricular work postresection, while left ventricular failure is a relative contraindication dependent on the response to treatment. Therefore postoperative inotropic support is seldom required, but the agent of choice, in the absence of systemic sepsis, would be dobutamine which increases contractility while reducing systemic and pulmonary vascular resistance.

Tachyarrhythmias are relatively common following thoracotomy, with the most common being atrial fibrillation and atrial flutter. In the past it was routine to digitalize all thoracotomy patients before surgery and to continue digoxin for a period of up to 6 weeks postoperatively. Even in thoracotomies for esophageal resection, pretreatment with digoxin offers no advantage (Ritchie.. et.a/ 1993); however, there may be a case for pretreatment in those individuals in whom a tachyarrhythmia would be particularly hazardous (e.g. pre-existing severe angina).

Ihe treatment of common atrial arrhythmias following thoracotomy is by conventional therapy with digoxin, verapamil, or amiodarone. Synchronized electrical conversion is used when there is significant hemodynamic instability. Caution should be advised in prescribing amiodarone since it may increase the incidence of acute respiratory distress syndrome following pneumonectomy (yan^Mjeghem^ et_ai 1994).

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