Acute Amiodarone Pulmonary Toxicity After Surgical Procedures

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.