N-Acetylcysteine and Postoperative Atrial Fibrillation: Comment

N-Acetylcysteine and Postoperative Atrial Fibrillation: Comment

“…3 Moreover, lobectomy removes more lung tissue than segmentectomy, which may induce myocardial hypoxia, thereby triggering atrial fibrillation. 2,4 A subgroup analysis of N-acetylcysteine effect according to surgical approach may be informative.…”

“…The primary outcome was the average numerical rating scale pain scores at rest during 72 h. The primary analysis evaluated whether liposomal bupivacaine was noninferior to bupivacaine with dexamethasone at a margin of 1.3 points. 2,3 Additional outcomes included opioid consumption, patient satisfaction, and duration of sensory and motor block at predefined time points up to 7 days postsurgery.…”

“…NADPH oxidase activity for postoperative atrial fibrillation, a plausible strategy for prophylaxis. 2 However, we have additional potential explanations for why there was no significant difference in the occurrence of postoperative atrial fibrillation in patients who did and did not receive perioperative N-acetylcysteine in the study of Amar et al 1 N-Acetylcysteine is an l-cysteine prodrug and glutathione precursor that, via l-cysteine conversion, helps scavenge oxygen-derived free radicals and binds metal ions into complexes, resulting in oxidative stress reduction. 3 However, as we showed in a previous study, which was done in rats and focused on the mesenteric artery, l-cysteine induces an oxygen-derived free radical, superoxide production mediated by NADPH oxidase in a high 95% oxygen condition.…”

N-Acetylcysteine and Postoperative Atrial Fibrillation: Reply

“…We thank Dr. Kinoshita and Dr. Kawashima, 1 and Dr. Wen, Dr. Huang, and Dr. Li 2 for their comments and their interest in our work. In the comments from Kinoshita and Kawashima, 1 they speculate that exposing our patients to a high fraction of inspired oxygen during one-lung ventilation negated the potential antioxidant effects of N -acetylcysteine during the 48 h after surgery.…”

“…Wen, Dr. Huang, and Dr. Li suggest the performance of a subgroup analysis by surgical modailty. 2 However, because of the small number of patients within the groups and the lack of power to do so, we did not perform a secondary subgroup analysis of the incidence of atrial fibrillation by type of surgery, whether open or minimally invasive. We have previously shown that the extent of lung resection affects the incidence of atrial fibrillation, and it is for this reason that we included patients who underwent anatomical lung or esophageal resection.…”