Digitalis in pneumonectomy and its implication.

Between 1968 and 1977, 87 patients underwent pneumonectomy at Rhode Island Hospital. Postoperatively, 25 patients developed arrhythmia (29 percent), giving rise to hemodynamic deterioration necessitating aggressive treatment. There were nine hospital deaths (10 percent). The effect of preoperative digitalis was analyzed in 68 patients over age 50 years.In Group 1, digoxin was not used until the onset of arrhythmia. There were 40 patients in this group; 18 developed arrhythmia (45 percent) with four deaths (22 percent).In Group 2, patients were given digitalis preoperatively. There were 28 patients; six developed arrhythmia (21 percent) with no deaths.Thus, the high incidence (45 percent in Group 1 and 21 percent in Group 2), as well as risk of mortality (4/18 patients) from arrhythmia following pneumonectomy, in patients over 50 years of age without digitalization, is a strong indication for preoperative digitalis.