From the Guidelines
For smokers undergoing surgery, the most effective approach to reduce perioperative complications is to prioritize smoking cessation for at least 4 weeks before the operation, as recommended by the Enhanced Recovery After Surgery (ERAS) society 1. When it comes to the use of salbutamol nebulization, the primary goal is to prevent bronchospasm during intubation and surgery in smokers with reactive airways.
- The recommended preoperative salbutamol (albuterol) nebulization regimen is typically 2.5 mg (0.5 mL of 0.5% solution diluted in 2-3 mL normal saline) administered via nebulizer 15-30 minutes before anesthesia induction.
- This regimen may be repeated once if wheezing or bronchospasm persists.
- For patients with more severe respiratory symptoms, the dose can be increased to 5 mg. The nebulization should be completed before entering the operating room, and vital signs should be monitored during administration as salbutamol can cause tachycardia. This prophylactic treatment helps prevent bronchospasm during intubation and surgery in smokers who have reactive airways due to chronic irritation from smoking. Salbutamol works as a beta-2 adrenergic agonist that relaxes bronchial smooth muscle, reducing airway resistance and improving ventilation. However, it's crucial to note that while salbutamol nebulization can help manage symptoms, smoking cessation remains the cornerstone of reducing perioperative complications in smokers, with a recommended cessation period of 4 to 8 weeks before surgery 1. Patients should be assessed for any contraindications such as tachyarrhythmias or hypersensitivity to the medication before administration. Given the most recent and highest quality evidence, prioritizing smoking cessation and using salbutamol nebulization as needed based on clinical judgment is the best approach to minimize morbidity, mortality, and improve quality of life for smokers undergoing surgery 1.
From the Research
Preoperative Salbutamol Nebulization for Smokers Undergoing Surgery
- The recommended preoperative salbutamol nebulization regimen for a smoker undergoing surgery is not directly addressed in the provided studies.
- However, study 2 suggests that aerosolized salbutamol can improve oxygenation and reduce extravascular lung water in patients at risk of lung edema after lung resection.
- Study 3 compares the performance of two nebulizer systems, "Ventstream" and "Hudson Updraft II", and finds that the "Ventstream" nebuliser produces a twofold greater concentration of plasma salbutamol and improves bronchodilator efficacy.
- Studies 4, 5, and 6 investigate the use of salbutamol in acute asthma and chronic obstructive airways disease, but do not provide specific guidance on preoperative nebulization for smokers undergoing surgery.
Key Findings
- Aerosolized salbutamol can improve oxygenation and reduce extravascular lung water in patients at risk of lung edema after lung resection 2.
- The "Ventstream" nebuliser produces a twofold greater concentration of plasma salbutamol and improves bronchodilator efficacy compared to the "Hudson Updraft II" nebuliser 3.
- There is no significant difference between continuous and intermittent nebulization of salbutamol in acute severe asthma 6.
Limitations
- The provided studies do not directly address the recommended preoperative salbutamol nebulization regimen for smokers undergoing surgery.
- Further research is needed to determine the optimal preoperative salbutamol nebulization regimen for smokers undergoing surgery.