Author of

• 12495

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  P3.07 - Poster Session 3 - Surgery (ID 193)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Surgery
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12537

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    P3.07-042 - Prophylactic landiolol administration can prevent atrial fibrillation after lobectomy? (ID 3062)

    09:30 - 09:30  |  Author(s): K. Kajiura
    • Abstract

    Background
    It is said that atrial fibrillation(Af) after lobectomy is seen in about 20%, sometimes difficulty in postoperative management. Landiolol is very short acting selective β1-blocker. It is reported that landiolol have the usefullness of not only treatment for Af, but also the prevention of Af after lobectomy. We had randamized control study about preventation of Af after lobectomy or more.

    Methods
    We divided into control group and landiolol administration group for patients to perform lobectomy or more. The patients of administration group are subjected prophylactic landiolol to 24hr continuous infusion from the start of surgery at 5γ. We analysed the 93 cases with informed consent in this clinical trial from June 2010 to April 2013. Finally, 2cases dropped out because of changing operative procedure for dissemination of lung cancer.

    Results
    45 cases is in landiolol administration group and 46 cases is in control group of 91 cases. Postoperative Af was occurred 10 cases. But, there were no occurrence of Af during landiolol infusion. 9 cases of 10 cases had Af during the 3days after surgery. The data is following: (administration group, control group) Event of Af=(6,4), postoperative days of Af=(1.5, 3.), age(years-old)=(70±8.7, 66.3±9.4), gender(M:F)=(25:20, 29:17), pasthistory of Af=(0, 5), operative site(R:L)=(29:16, 31:15), bleeding=(286±463ml, 212±308ml), operation time=(290±86min,272±87min), in-out balance in operation=1816±827ml, 1414±732ml), the rate of concomittant use of epidural anethesia=(91%:95%), operatibe approach(open:VATS)=(6:39, 10:36), operative procedure(lobectomy:bilobectomy:pneumonectomy)=(45:0:0, 40:3:3), upper mediastinal LN disection rate=(67%, 63%), #7 LN disection rate=(73%, 70%). Adverse effect of landiolol is hypotension(BP<80) in 3 cases(7%) and bradycardia(HR<60) in 1 case.

    Conclusion
    Landiolol administration group had more occurrence of postoperative Af, compared to control group. Considering the incidence of Af is high up to 3days after surgery, only 24hr continuous administration can not suppress Af after stopping infusion. β- action, by exciting sympathetic nerve, is important for the occurrence of postoperative Af. β- action is inhibited by landiolol during administration, for positive feedback, β-receptor are upregulation. It is thought that Af occurrence after stopping landiolol is increasing in administration group than control group, because the β-agonist binds to the upregulated receptor. It is possible that turned out to be different result, if prophylactic landiolol administration would continue until 3days after surgery, for Af is high up to 3days after surgery.