Short-acting Beta2 Adrenoreceptor Agonists (Inhaled, Nebulised and Oral)


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)

Oral preparations
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.

 
Post-operative Advice
Oral preparations
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


Halogenated Anaesthetics
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


Corticosteroids
Dexamethasone and hydrocortisone may cause hypokalaemia which would potentiate any short-acting betaadrenoceptor 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.


  Further Information


None relevant.

 

  References


  1. Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. http://about.medicinescomplete.com [Accessed on 27th June 2021]
  2. Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://about.medicinescomplete.com [Accessed on 27th June 2021]
  3. 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]
  4. 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]
  5. 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]