Inhaled furosemide ameliorates wheezes in asthmatic patients during induction of anesthesia

ABSTRACT

Fifty asymptomatic asthmatic patients of ASA physical status, I and II, with a history of active asthma scheduled for elective surgery were enrolled in the study. Anesthetic management was the same in all patients. Five minutes post-intubation an independent blinded observer assessed wheezing. The presence of wheezing was determined through auscultation during controlled ventilation. A simple "yes" or "no" was obtained, and no grading was done. Patients who wheezed after 5 min were subsequently treated by the random administration of the study medication either albuterol [5 mg in 2-4 ml 0. 9%NaCl, salbutamol sulphate I mg /ml] or furosemide [lasix 40 mg in 2-4 ml 0.9% NaCl]. Wheezes were assessed again. 5 minutes post-medication. Twenly-three out of 50 patients included in the study developed wheezes, 5 minutes after intubation. The incidence of wheezes was 46% and the mean peak inspiratory pressure [PIP] was 26.1 +/- 2.6 cm H2O The patients who wheezed were randomly allocated into one of two groups to receive either albuterol [n =11] or furosemide [n=12]. There was no statistically significant difference in the percentage of patients who responded to albuterol [82%] in comparison to furosemide [75%]. The peak inspiratory pressure [PIP] declined significantly [P= 0.001], 5 minutes after treatment in both groups. Heart rate was significantly higher [P= 0.001], 5 minutes after treatment, in the albuterol group [104.1 +/- 11.25 bpm] in comparison to furosemide group [82.3 +/- 7.53 bpm]. Inhaled furosemide has definitely a role in ameliorating wheezes in asthmatic patients during general anesthesia. It is equally effective to inhaled albuterol however, it unduces no tachyarrythmias. Those who are suffering complications from the adverse effects of beta 2-agonists may benefit from the use of inhaled furosemide