Original Article
Serial Observation of Blood Alcohol Concentration post Ethanol Pleurodesis (SOBER) Study: A Prospective Observational Study

https://doi.org/10.1053/j.jvca.2019.03.048Get rights and content

Objectives

To measure the blood alcohol concentration levels in patients after chemical pleurodesis with ethanol sclerosant via video-assisted thoracoscopic surgery.

Design

Prospective observational study.

Setting

Single tertiary university hospital.

Participants

Eight patients undergoing chemical pleurodesis with ethanol sclerosant for management of recurrent pneumothoraces or pleural effusions.

Interventions

After ethics board approval, written informed consent was obtained from 8 patients undergoing chemical pleurodesis with ethanol sclerosant for management of recurrent pneumothoraces or pleural effusions. Five patients received a dose of 100 mL of 70% ethanol/1% iodine, and 3 patients received 30 mL. Blood alcohol concentration measurement was obtained at 30, 60, 90, and 120 minutes after the ethanol was instilled in the interpleural space. The postoperative quality of recovery scale was conducted preoperatively and then at 30 and 60 minutes postoperatively and on postoperative days 1 and 3.

Measurements and Main Results

The highest observed blood alcohol concentration was recorded at 30 minutes post-instillation of ethanol in all patients. The blood alcohol concentration peak for 75% of patients (6/8) was >0.05 g/dL at 30 minutes post-instillation of ethanol, and for 4 patients (50%), this remained >0.05 g/dL at 60 minutes. The median area under curve of ethanol absorbed was 5.66 g/dL/min (3.24-7.29).

Conclusions

Significant systemic absorption of ethanol can occur after instillation of ethanol sclerosant, which potentially may affect the quality of recovery in patients. Postoperative management of these patients may need to be specifically tailored to take into account these observations.

Section snippets

Methods

Ethics board approval was obtained from the authors’ institution. Adult patients at least 18 years old presenting for VATS pleurodesis surgery at the authors’ institution and with planned arterial line placement for the surgery were recruited for the study. Written, informed consent was obtained from all participants.

BAC measurement was obtained from direct arterial blood samples from the arterial line placed preoperatively as standard practice for VATS until removal of the line in the

Results

Eight patients were recruited for this study. The median age of patient (IQR) was 23.5 years (19.5-32.5), and the median weight (IQR) was 62 kg (58.5-70.5) (Table 1). From the standard preadmission questionnaires completed before surgery, 5 patients did not drink alcohol, 1 patient consumed 1 standard drink per week, 1 patient consumed 2 to 3 standard drinks per week, and 1 patient consumed 4 standard drinks per week.

The anesthetic technique used was decided upon by the individual practitioner.

Discussion

This is the first study to examine the absorption of ethanol systemically after its use as a sclerosant for pleurodesis and the recovery of patients from this surgery. The majority of study participants absorbed enough ethanol from direct instillation to the pleural space to raise their BAC >0.05 g/dL at the 30-minute time point. This level generally is accepted to result in a significant impairment of motor and cognitive function. In addition, the BAC remained elevated >0.05 g/dL for 1 hour in

Acknowledgments

The authors would like to acknowledge Dr. Mari Kawamata for her assistance in examining the rates of video-assisted thoracoscopic pleurodesis surgery at Western Health. The authors would also like to acknowledge the PostopQRS Ltd company (www.postopqrs.com) for the use of the PostopQRS in this study.

Declarations of Interest

None.

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