Salbutamol (Airomir®, Salamol®, Ventolin®), Terbutaline (Bricanyl®)
Issues for Surgery
For asthma and chronic obstructive pulmonary disease (COPD) – no symptomatic relief of acute exacerbation if omitted.
Advice in the Perioperative period
Elective and Emergency Surgery
Continue – including the following combination product:
- Salbutamol with ipratropium (also see Inhaled Antimuscarinics monograph)
Consider checking serum potassium pre-operatively.
Inhaled or Nebulised preparations
If patient requiring several ‘reliever’ doses per week confirm adherence to any prescribed ‘preventer’ medication before considering addition / up-titration of ‘preventer’ medication to optimise disease control prior to elective surgery.
Confirm the inhaler device with patient.
Restart post-operatively, at usual dose, as soon as next dose is due.
If patients are unable to resume their usual oral short-acting beta2 adrenoceptor agonist post-operatively consideration should be given to alternative routes of administration.
Inhaled or Nebulised preparation
Restart when required post-operatively.
Interaction(s) with Common Anaesthetic Agents
Short-acting beta2 adrenoceptor agonists may cause hypokalaemia1, 2, 3, 4, 5. Concomitant use with medications that prolong the QT-interval (e.g. desflurane, isoflurane, sevoflurane and possibly thiopental) increases the risk of torsades de pointes1, 2, 3. Monitor serum potassium and QT-interval with concomitant treatment.
Interaction(s) with other Common Medicines used in the Perioperative Period
Dexamethasone and hydrocortisone may cause hypokalaemia which would potentiate any short-acting beta2 adrenoceptor agonist mediated hypokalaemia1, 2, 3, 5. Hypokalaemia increases the risk of torsades de pointes with medicines which prolong the QT-interval e.g. antiemetics (domperidone, droperidol, granisetron, haloperidol, ondansetron and possibly prochlorperazine), antimicrobials (ciprofloxacin, clarithromycin, erythromycin) and loperamide1, 2.
- Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. http://about.medicinescomplete.com [Accessed on 27th June 2021]
- Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://about.medicinescomplete.com [Accessed on 27th June 2021]
- Summary of Product Characteristics – Bricanyl® (terbutaline) Turbohaler, 0.5mg/dose, inhalation powder. AstraZeneca UK Limited. Accessed via www.medicines.org.uk 27/06/2021 [date of revision of the text March 2021]
- Summary of Product Characteristics – Ventolin® (salbutamol) Evohaler 100 micrograms. GlaxoSmithKline UK. Accessed via www.medicines.org.uk 27/06/2021 [date of revision of the text December 2019]
- Summary of Product Characteristics – Salbutamol 2 mg Tablets BP. Accord-UK Ltd. Accessed via www.medicines.org.uk 27/06/2021 [date of revision of the text February 2021]