Safety of Landiolol Infusion in Patients Undergoing Lung Resection


The efficacy of landiolol hydrochloride, an ultrashort-acting b-blocker with high b1 selectivity, has been confirmed in patients undergoing cardiac surgery in Japan, but there have been few reports about its use for patients having lung resection. We investigated the safety of continuous infusion of landiolol in patients undergoing lung resection. Between May 2008 and May 2011, 200 patients scheduled for lung resection were enrolled. Patients who underwent surgery before the introduction of landiolol in February 2010 were studied retrospectively (Group C) and were compared with those who received landiolol along with surgery (Group L). During the 48-hour study period, the incidence of arrhythmias, changes in heart rate and blood pressure, and occurrence of adverse reactions were examined. The white blood cell count and C-reactive protein level were measured before and after surgery to assess the anti-inflammatory effect. The heart rate was significantly lower in Group L throughout the study period. No patient in Group L developed hypotension requiring discontinuation of landiolol therapy, and no respiratory symptoms (including asthma or hypoxemia) were observed. White blood cell and C-reactive protein were significantly increased after surgery in both groups, and there were no between-group differences. Arrhythmic events occurred in 1.1% (1/99) and 9.2% (7/76) of Group L and Group C, respectively. One patient in Group C developed ventricular tachycardia. Landiolol can be administered safely during the perioperative period in patients undergoing lung resection.

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Ito, K. , Nozaki, M. , Sakamoto, R. , Suzuki, T. , Masuda, R. and Iwazaki, M. (2014) Safety of Landiolol Infusion in Patients Undergoing Lung Resection. Open Journal of Anesthesiology, 4, 183-190. doi: 10.4236/ojanes.2014.48026.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Sezai, A., Shiono, M. and Kato, J. (2010) Expectation for Ultra Short Acting Beta-Blocker in Cardiac Surgery: New Evidence from the PASCAL Trial. Rinsyomasui (Journal of Clinical Anesthesia), 34, 1243-1250 (in Japanese).
[2] Villareal, R.P., Hariharan, R., Liu, B.C., Kar, B., Lee, V.V., Elayda, M., Lopez, J.A., Rasekh, A., Wilson, J.M. and Massumi, A. (2004) Postoperative Atrial Fibrillation and Mortality after Coronary Artery Bypass Surgery. Journal of the American College of Cardiology, 43, 742-748.
[3] Mariscalco, G., Klersy, C., Zanobini, M., Banach, M., Ferrarese, S., Borsani, P., Cantore, C., Biglioli, P. and Sala, A. (2008) Atrial Fibrillation after Isolated Coronary Surgery Affects Late Survival. Circulation, 118, 1612-1618.
[4] Park, B.J., Zhang, H., Rusch, V.W. and Amar, D. (2007) Video-Assisted Thoracic Surgery Does Not Reduce the Incidence of Postoperative Atrial Fibrillation after Pulmonary Lobectomy. Journal of Thoracic and Cardiovascular Surgery, 133, 775-779.
[5] Fuster, V., Rydén, L.E., Cannom, D.S., Crijns, H.J., Curtis, A.B., Ellenbogen, K.A., Halperin, J.L., Le Heuzey, J.Y., Kay, G.N., Lowe, J.E., Olsson, S.B., Prystowsky, E.N., Tamargo, J.L., Wann, S., Smith, S.C. Jr, Jacobs, A.K., Adams, C.D., Anderson, J.L., Antman, E.M., Halperin, J.L., Hunt, S.A., Nishimura, R., Ornato, J.P., Page, R.L., Riegel, B., Priori, S.G., Blanc, J.J., Budaj, A., Camm, A.J., Dean, V., Deckers, J.W., Despres, C., Dickstein, K., Lekakis, J., McGregor, K., Metra, M., Morais, J., Osterspey, A., Tamargo, J.L., Zamorano, J.L., American College of Cardiology/American Heart Association Task Force on Practice Guidelines, European Society of Cardiology Committee for Practice Guidelines, European Heart Rhythm Association, and Heart Rhythm Society (2006) ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation, 114, 257-354.
[6] Crystal, E., Connolly, S.J., Sleik, K., Ginger, T.J. and Yusuf, S. (2002) Interventions on Prevention of Postoperative Atrial Fibrillation in Patients Undergoing Heart Surgery: A Meta-Analysis. Circulation, 106, 75-80.
[7] Shiroya, T., Ichioka, Y., Yoshida, K., Nishijima, K., Omawari, N., Naka, M., Kondo, K. and Kohjimoto, Y. (1997) Pharmacological Studies of ONO-1101 as a β-blocking Agent with High β1-Selectivity and Ultra-Short Duration of Action. Kiso to Rinsho (Clinical Report), 31, 2913-2923 (in Japanese).
[8] Okita, T., Uji, M., Shinjo, T., Morioka, M., Kumano, H., Ishimura, N. and Nishiwada, M. (2008) Use of Landiolol Hydrochloride for the Prevention of Atrial Fibrillation after Lung Resection. Masui (Japanese Journal of Anesthesiology), 57, 953-958 (in Japanese).
[9] Jakobsen, C.J., Bille, S., Ahlburg, P., Rybro, L., Hjortholm, K. and Andresen, E.B. (1997) Perioperative Metoprolol Reduces the Frequency of Arterial Fibrillation after Thoracotomy for Lung Resection. Journal of Cardiothoracic and Vascular Anesthesia, 11, 746-751.
[10] Bayliff, C.D., Massel, D.R., Inculet, R.I., Malthaner, R.A., Quinton, S.D., Powell, F.S. and Kennedy, R.S. (1999) Propranolol for the Prevention of Postoperative Arrhythmias in General Thoracic Surgery. Annals of Thoracic Surgery, 67, 182-186.
[11] Nakano, T., Shimizu, K., Kawashima, O., Kamiyoshihara, M., Nagashima, T., Ibe, T. and Takeyoshi, I. (2012) Effect of Landiolol Hydrochloride, an Ultra-Short-Acting Beta 1-Selective Blocker, on Supraventricular Tachycardia, Atrial Fibrillation and Flutter after Pulmonary Resection. Journal of Clinical Pharmacy and Therapeutics, 37, 431-435.
[12] Sezai, A., Minami, K., Nakai, T., Hata, M., Yoshitake, I., Wakui, S., Shiono, M. and Hirayama, A. (2011) Landiolol Hydrochloride for Prevention of Atrial Fibrillation after Coronary Artery Bypass Grafting: New Evidence from the PASCAL Trial. Journal of Thoracic and Cardiovascular Surgery, 141, 1478-1487.
[13] Sakamoto, A., Kitakaze, M., Takamoto, S., Namiki, A., Kasanuki, H., Hosoda, S. and JL-KNIGHT Study Group (2012) Landiolol, an Ultra-Short-Acting β(1)-Blocker, More Effectively Terminates Atrial Fibrillation Than Diltiazem after Oopen Heart Surgery. Circulation Journal, 76, 1097-1101.
[14] Goto, K., Hagiwara, S., Hidaka, S., Yamamoto, S., Kusaka, J., Yasuda, N., Shingu, C. and Noguchi, T. (2010) The Effect of Landiolol on Cerebral Blood Flow in Patients Undergoing Off-Pump Coronary Artery Bypass Surgery. Journal of Anesthesia, 24, 11-16.
[15] Cardinale, D., Colombo, A., Sandri, M.T., Lamantia, G., Colombo, N., Civelli, M., Salvatici, M., Veronesi, G., Veglia, F., Fiorentini, C., Spaggiari, L. and Cipolla, C.M. (2007) Increased Perioperative N-Terminal Pro-B-Type Natriuretic Peptide Levels Predict Atrial Fibrillation after Thoracic Surgery for Lung Cancer. Circulation, 115, 1339-1344.
[16] Kim, D.H. and Park, J.C. (2007) Completion Sleeve Pneumonectomy for Suture Line Recurrence of Lung Cancer after Sleeve Lobectomy. Thoracic and Cardiovascular Surgeon, 55, 512-514.
[17] Hollings, D.D., Higgins, R.S., Faber, L.P., Warren, W.H., Liptay, M.J., Basu, S. and Kim, A.W. (2010) Age Is a Strong Risk Factor for Atrial Fibrillation after Pulmonary Lobectomy. American Journal of Surgery, 199, 558-561.
[18] Kikuchi, Y., Ushijima, T., Ikeda, C., Takata, M. and Yamamoto, Y. (2009) Concomitant Use of Epidural Anesthesia in Off-Pump Coronary Artery Bypass Grafting for Effective Suppression of Atrial Fibrillation. Tokyo Ika Daigaku Zasshi (Journal of Tokyo Medical College), 67, 439-449 (in Japanse).
[19] Nojiri, T., Maeda, H., Takeuchi, Y., Funakoshi, Y., Kimura, T., Maekura, R., Yamamoto, K. and Okumura, M. (2010) Predictive Value of B-Type Natriuretic Peptide for Postoperative Atrial Fibrillation Following Pulmonary Resection for Lung Cancer. European Journal of Cardio-Thoracic Surgery, 37, 787-791.

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