Is salbutamol a useful pre-med for asthmatic children?

Without you I get weak, and I can’t breathe, and I can’t breathe – Leona Lewis.
Paper aim: Investigate whether premedication with Salbutamol inhaler reduced the incidence of perioperative respiratory adverse events.
Methodology and population: This was a double blinded, randomised control trial in a tertiary paediatric centre in Australia. Four hundred and seventy children aged 6-16 with at least 2 risk factors for developing perioperative respiratory adverse events (PRAEs) were recruited from the elective surgery lists. They were randomly allocated to receive disguised salbutamol or placebo inhaler using a spacer one hour before surgery.
Outcomes analysed: THE Primary aim was to investigate if inhaled salbutamol premedication decreased the occurrence of PRAE. Secondary aims were to test if salbutamol worked for patients with current respiratory symptoms, whether salbutamol affected the incidence of PRAE at different time points during surgery and if salbutamol administration decreased the length of recovery stay.
Paper findingsThere were NO significant difference between the overall rate of PRAE in the salbutamol group and the placebo group. Notably, the reported rate of PRAE is 12-14%. In sub-group analyses, no significant differences were found at any time points (it appears that most PRAEs occurred on emergence and in recovery). Premedication with salbutamol did not reduce the length of recovery stay.
Analysis of paper:  This is a reasonably well conducted and clinically relevant study. There were clear inclusion and exclusion criteria, with minimal drop-out. The study protocol appears well designed. It’s adequately randomised and blinded. However, the choice of anaesthetic agent was not recorded or controlled in this study, neither was the administration of any bronchoactive agents. In addition, there are also possible issue surrounding selection and recall bias.
Conclusion: Despite the limitations, this is a fairly large study and it demonstrated reasonably robustly that salbutamol does not reduce the risk of perioperative respiratory adverse events in at risk patients. Clinically its benefit may be limited.

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