title: Acute Amiodarone Pulmonary Toxicity After Surgical Procedures.
abstract: Amiodarone can cause toxicity in several organs, including amiodarone-induced pulmonary toxicity which is a subacute or chronic complication. Amiodarone-induced acute respiratory distress syndrome (ARDS) in postoperative patients is a rare acute complication. The PubMed and Google Scholar databases were searched. Seven retrospective and prospective case series and 10 case reports of amiodarone-induced postoperative ARDS were reviewed. All patients received amiodarone chronically or during the perioperative period. Forty-three out of 285 patients (15%) reported in the retrospective and prospective studies developed amiodarone-induced ARDS. Most of the patients were men in age group 60-80 who had undergone cardiothoracic surgery. All patients had general anesthesia and exposure to high concentrations of oxygen. The onset of symptoms ranged from 2 hours to 2 weeks after surgery. The mortality rate of amiodarone-induced ARDS after surgery was approximately 10%. Ten case reports were evaluated using Naranjo criteria. Two cases had definite amiodarone toxicity, and 8 had probable toxicity based on these criteria. The incidence of amiodarone-induced postoperative ARDS was approximately 15% in these studies. Most operations involved cardiothoracic surgery. Elderly patients on high-dose and long-term amiodarone treatment were at increased risk. This diagnosis is challenging owing to the lack of definite diagnostic criteria; careful clinical evaluation and early drug withdrawal may reduce the severity of this complication.
authors.affiliation: Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas.
authors.forename: Jirapat
authors.initials: J
authors.lastname: Teerakanok
authors.affiliation: Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas.
authors.forename: Pakpoom
authors.initials: P
authors.lastname: Tantrachoti
authors.affiliation: Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas.
authors.forename: Phumpattra
authors.initials: P
authors.lastname: Chariyawong
authors.affiliation: Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas. Electronic address: kenneth.nugent@ttuhsc.edu.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Nugent
mesh_terms: D000638:Amiodarone / Q000009:adverse effects*; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects*; D006801:Humans; D011183:Postoperative Complications / Q000139:chemically induced*; D012128:Respiratory Distress Syndrome / Q000139:chemically induced*
chemical_list: D000889:Anti-Arrhythmia Agents; D000638:Amiodarone
keywords: Acute respiratory distress syndrome; Amiodarone; Complication; Surgery; Toxicity