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Thorax 2000;55:497-501 doi:10.1136/thorax.55.6.497
  • Original article

Effect of digoxin on global respiratory muscle strength after cholecystectomy: a double blind study

  1. N M Siafakasa,c,
  2. M Stathopoulouc,
  3. N Tzanakisa,
  4. I Mitrouskaa,
  5. M Tsoumakidoua,
  6. D Georgopoulosb
  1. aDepartment of Thoracic Medicine, Medical School, University General Hospital, 71110 Heraklion, Crete, Greece, bIntensive Care Unit, cDepartment of Thoracic Medicine, Evangelismos Hospital, Athens, Greece
  1. Dr N M Siafakas email:siafakas{at}med.uoc.gr
  • Received 2 September 1999
  • Revision requested 4 November 1999
  • Revised 22 February 2000
  • Accepted 3 March 2000

Abstract

BACKGROUND Upper abdominal surgery has been shown to impair the function of the respiratory muscles. In addition, controversial results have been reported concerning the effect of digoxin on the diaphragm. The aim of this study was to investigate further the mechanism(s) of respiratory muscle dysfunction after cholecystectomy and the effect of digoxin on the impaired respiratory muscle function.

METHODS Twenty three patients (four men) were studied before and 48 hours after surgery. Eleven received digoxin and 12 placebo. Respiratory muscle strength was assessed 48 hours after surgery by measuring mouth pressure during maximum static inspiratory (Pimax) and expiratory (Pemax) efforts before and after 90 minutes of intravenous administration of 0.25 mg digoxin in a double blind, placebo controlled fashion. In addition, spirometric and pain measurements were performed.

RESULTS Postoperatively (+48 h) Pimax and Pemax decreased significantly (p<0.01) from their preoperative values in both groups by a similar degree. After administration of digoxin or placebo only the digoxin group showed a significant increase in both Pimax (p<0.02) and Pemax (p<0.05) with a mean increase of 15% for Pimax and 12.3% for Pemax. The mean difference in PImax (ΔPimax) and Pemax (ΔPemax) between the digoxin and placebo groups was 1.01 (95% CI 0.28 to 2.2) and 1.05 (95% CI 0.04 to 2.4), respectively. Estimates of postoperative pain did not differ between the two groups. Spirometric indices showed a similar restrictive defect postoperatively in both groups but did not change after digoxin or placebo.

CONCLUSION Digoxin improves the impaired global strength of the inspiratory and expiratory muscles after cholecystectomy and this may be clinically relevant. Muscle contractility could play a part in this impairment.

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