Discussion
chronic arterial insufficiency, anxiety, hypoxia, wheezing, edema, emphysema, COPD, cough, infection, bronchitis, depressed, acute respiratory distress syndrome, bronchospasm
ANTITUSSIVE, POSTOPERATIVE COMPLICATIONS, HYPOXIA, EDEMA, CONTRACTION, EMPHYSEMA, INFECTION, COPD, BRONCHITIS, BRONCHOSPASM, ACUTE RESPIRATORY DISTRESS SYNDROME, COMPLICATIONS
The results of the present study showed that wheezing and frequent coughing before induction of anesthesia (after administration of albuterol spray) in the intervention group (receiving albuterol spray) were less in the intervention group than the control group. Also, wheezing and bronchospasm before tracheal extubation (after re-administration of albuterol spray) were less in the intervention group than in the control group.A study by Etamadi et al. showed that out of 30 heavy smoking patients during general anesthesia who received salbutamol spray, 21 had no problems, and only 9 patients from this group had bronchospasm or wheezing or irritating cough or decreased oxygen saturation. Also, out of 30 patients in the control group, 13 were without complications while 17 patients of this group had one or more complications such as bronchospasm, wheezing, irritating cough, and depressed blood oxygen saturation, which were resolved with the necessary medical measures. None of the patients had acute respiratory distress syndrome after surgery (In the study of Imantalab et al. on 225 heavy smoking patients who had a history of smoking (20 packs/year) with normal spirometry and without any respiratory symptoms, who underwent coronary artery bypass surgery, patients were divided into 3 groups (75 in each group).In the first group were the smoking patients who had not been treated and had smoked before the surgery. The second group consisted of smoking patients who were treated with 3 drugs, Salbutamol-Atronet-Beclomethasone, inhaled 2 puffs twice a day, 10 to 14 days before the surgery, and they had smoked before the operation. In the third group were smokers who had quit smoking for 8 weeks. In the first, second and third groups, out of 75 patients, 35, 23 and 31 suffered from at least one postoperative complications. The frequency of coughing and wheezing and the average duration of mechanical ventilation and the incidence of reoperation due to repeated coughing in the group that was treated with salbutamol-atronate-beclomethasone were statistically lower than the other two groups (Smoking is a major trigger of chronic mucus hyper-secretion, decreases the protective host responses to infection, impairs the capability of cilia to clear mucus and causes air flow obstruction. Also, due to the occurrence of hypoxia in these patients, pulmonary vascular resistance and blood viscosity increase (Ninety percent of smoking patients have chronic arterial insufficiency. Although patients are advised for cessation of smoking 8 to 12 weeks before elective surgery or at least 18 hours before surgery, it is observed that these patients continue their smoking habit. The harmful substances in cigarette smoke are not fully known. Some of these substances produce bronchitis in the trachea and large bronchi, and others cause emphysema in smaller bronchioles and alveoli (Albuterol is a β2 agonist whose possible mechanisms of action include relaxation of bronchial smooth muscles, stimulation of mucociliary clearance, stabilization of mesenteries, reduction of edema caused by increased vascular permeability, reduction of pulmonary artery pressure, improvement of diaphragm contraction and inhibition of transmission of parasympathetic ganglia in the airways. Beta-agonists have antitussive effects, due to the drug's effect on endothelial and epithelial permeability, inhibiting the release of mediators, and stimulating mucociliary clearance (The results of a study by Kim, Eun et al., who investigated the effects of albuterol administration before intubation on the emergence coughing are inconsistent with the present study. In that study, the researchers concluded that emergence coughing is very common, and smoking has no effect on cough during emergence from anesthesia. Also, using albuterol has no beneficial effect on emergence coughing (Also, in the study of Hurwitz et al. it was shown that smoking reduced the function of pulmonary vessels and airways, so that albuterol consumption did not cause a significant decrease in pulmonary vascular resistance in both smoking and non-smoking groups. However on the other hand, it caused a greater decrease in airway vascular resistance in non-smokers than in smokers (There were some limitations to our study. We did not assess some potential confounders in this study such as preoperative anxiety. Moreover, determining the exact dosage of albuterol that reached the bronchus under the administration of metered-dose inhaler was difficult. In addition, the absence of preoperative pulmonary function data was another limitation of this study.In conclusion, according to the results of the preset study, it seems that using one puff of albuterol spray (2.5 micrograms) before induction of anesthesia can significantly reduce wheezing and frequent coughing in COPD patients under general anesthesia. Also, re-administration of one puff of albuterol spray (2.5 micrograms) before tracheal extubation can significantly reduce wheezing and bronchospasm compared to the control group. In other words, the preventive use of albuterol spray will be useful in reducing the incidence of bronchospasm and hypoxia, and frequent coughing after anesthesia in COPD patients who smoke.