Lung protective effects of budesonide nebulization during perioperative period of thoracolumbar fusion

To determine the pulmonary protective effect of budesonide nebulization in patients undergoing spinal fusion for thoracolumbar degenerative disorders.

Forty patients who underwent spinal fusion at our hospital from January 2013 to December 2013 for the treatment of thoracolumbar degenerative disorders were randomly allocated into a budesonide intervention group (budesonide group) and a control group. The control group received routine supportive therapy including rehydration, analgesia, and neurotrophic drug treatment; in addition to these, the budesonide group was administered with budesonide nebulization (1-mg budesonide/2-mL saline, twice daily) from 1 day preoperatively through 3 days postoperatively. Respiratory symptoms, arterial blood gas, and pulmonary complication before and after the operations were observed and compared between the two groups.

The patients ranged in age from 46 to 81 years old (mean, 62.4±9.4 years), and comprised 20 men and 20 women. There were no significant differences in postoperative body temperature, heart rate, and respiratory rate between the groups (P>0.05). The change in arterial partial pressure of oxygen (PaO2) from baseline was significantly lower in the budesonide group than in the control group (at 2.4±12.4 vs. 16.0±11.3 mmHg) (P=0.002), so was the findings for oxygen saturation (SpO2) (0.2%±2.3% vs. 2.6%±3.3%), respectively (P=0.047). The incidence of postoperative pulmonary symptoms and complications, such as coughing, shortness of breath, and dyspnea, was 0% in the budesonide group and 15% in the control group; overall, the budesonide group performed better than control group in all pulmonary parameters. None of the patients in the budesonide group experienced severe events associated with glucocorticoid therapy.

Perioperative budesonide nebulization may reduce the postoperative pulmonary complications in middle-aged and elderly patients undergoing thoracolumbar fusion to treat thoracolumbar degeneration, with favorable efficacy and safety.