Arterial Oxygenation during One-lung Ventilation

1995 ◽  
Vol 82 (4) ◽  
pp. 940-946. ◽  
Author(s):  
P. Slinger ◽  
W. A. C. Scott
Keyword(s):  
Cardiac Output ◽  
Hypoxic Pulmonary Vasoconstriction ◽  
Volatile Anesthetic ◽  
Lung Ventilation ◽  
Clinical Problem ◽  
Arterial Oxygenation ◽  
One Lung Ventilation ◽  
Anesthetic Agents ◽  
Minimal Trauma ◽  
The Difference

Background Because maintaining arterial oxygenation (PaO2) during one-lung ventilation (OLV) can be a clinical problem, it is useful to be aware of factors that influence PaO2 in this situation and are under the control of the anesthesiologist. It is unknown whether, among the commonly used volatile anesthetic agents, one is associated with higher PaO2 levels. Clinical studies suggest that isoflurane provides superior PaO2 during OLV than does halothane. These have not been compared to enflurane. The authors studied PaO2 and hemodynamics during OLV with 1 MAC enflurane versus 1 MAC isoflurane. Methods Twenty-eight adults who had prolonged periods of OLV anesthesia with minimal trauma to the nonventilated lung (thoracoscopic or esophageal surgery) were studied in a cross-over design. Patients were randomized to two groups: Group 1 received 1 MAC enflurane in oxygen from induction until after the first 30 min of OLV, then were switched to 1 MAC isoflurane. In group 2, the order of the anesthetics was reversed. Results Isoflurane was associated with higher PaO2 values during OLV (P < 0.0001). Mean PaO2 (+/- SD) after 30 min OLV isoflurane was 231 (+/- 125) mmHg versus 184 (+/- 106) mmHg after 30 min OLV enflurane. The difference in PaO2 between the two anesthetics was most marked in the patients with the highest PaO2 during OLV: PaO2 isoflurane PaO2 enflurane varies; is directly proportional to PaO2 isoflurane (r = 0.65, P < 0.001). There were no other significant differences between anesthetic gases in the measured hemodynamic or respiratory variables. In the subgroup of patients with pulmonary artery catheters (n = 7), PaO2 correlated with cardiac output during OLV for both anesthetics (r = 0.81, P < 0.001). Conclusions During OLV, the PaO2 values with 1 MAC isoflurane were greater than those with enflurane. The dependence of PaO2 on cardiac output does not support the hypothesis that an increase in cardiac output will cause a decrease in hypoxic pulmonary vasoconstriction and a decrease in PaO2 during OLV.

Abstract 17224: Volatile Anesthetic Agents Increase Cerebral to Systemic Blood Flow Ratio in Children Undergoing Cardiac Magnetic Resonance Imaging

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Amulya Buddhavarapu ◽  
Luisa Raga ◽  
Euleche Alanmanou ◽  
Prashob Porayette
Keyword(s):  
Magnetic Resonance Imaging ◽  
Blood Flow ◽  
Cardiac Output ◽  
Volatile Anesthetic ◽  
Flow Reversal ◽  
Lower Body ◽  
Flow Ratio ◽  
Resonance Imaging ◽  
Anesthetic Agents ◽  
Cerebral Vasodilation

Introduction: Cardiac magnetic resonance imaging (CMR) can reliably assess hemodynamics in children. Anesthetic agents may affect cerebral blood flow (CBF) and change the cerebral to systemic perfusion ratio. Hypothesis: Volatile anesthetic agents cause significant cerebral vasodilation resulting in descending aorta (DAo) flow reversal. Methods: Blood flow was measured in patients who underwent cine phase contract velocity mapping during CMR (1.5T, Philips Ingenia, Amsterdam, The Netherlands) with or without general anesthesia (GA) at our institution. Patients with a known cause for flow reversal in DAo (e.g. aortic insufficiency, aorto-pulmonary shunt/collaterals) or brain pathology were excluded. Flows in superior vena cava (SVC, surrogate for CBF), ascending aorta (AAo, measure of cardiac output), and DAo (measure of lower body perfusion) were analyzed. Measures of central tendency, standard deviation, correlation coefficient and Student’s t-test were calculated. Variables including anesthetic agents, body surface area (BSA), mechanical ventilator parameters and vital signs were assessed. Results: A total of 93 CMR scans were performed with GA (n=43, age 3 m to 15 y, BSA 0.29-2.4 m 2 ) or without GA (n=50, 2 w to 21 y, BSA 0.2-2.89 m 2 ). There was significant flow reversal in DAo (mean 7.62% +/- SD 7%) in GA group using volatile agents compared to non-GA patients (1.16% +/- 1.78%; p-value <0.001). SVC flow was higher in GA (1.66+/-1.02 ml/min/m 2 ) than non-GA patients (1.28+/-0.53 ml/min/m 2 ) but did not reach statistical significance (p=0.06). GA group had significantly higher SVC (cerebral blood) to AAo flow (cardiac output) ratio (0.53 +/- 0.13) than non-GA group (0.44 +/- 0.17; p=0.003), probably from increased CBF from cerebral vasodilation by volatile anesthetic agents. Patients with BSA >1.2 m 2 and GA (0.84 +/- 0.27) had a tendency to have higher SVC/DAo flow ratio compared to non-GA (0.69 +/- 0.3; p = 0.06) patients. There was a positive correlation between the end tidal CO 2 and SVC flow (r 0.486, R 2 0.236). Conclusions: The flow rates of SVC, AAo and DAo using CMR must be interpreted with caution in children, taking into account the effects of GA on the cerebral and lower body perfusion. This difference may be relevant in patients with congenital heart disease, especially with cavo-pulmonary and Fontan circulation.

scholarly journals A Randomized Controlled Trial Comparing Novel Triple-Cuffed Double-Lumen Endobronchial Tubes with Conventional Double-Lumen Endobronchial Tubes for Lung Isolation

2020 ◽  
Vol 9 (4) ◽  
pp. 977
Author(s):  
Namo Kim ◽  
Hyo-Jin Byon ◽  
Go Eun Kim ◽  
Chungon Park ◽  
Young Eun Joe ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Fiberoptic Bronchoscopy ◽  
Lung Ventilation ◽  
One Lung Ventilation ◽  
Double Lumen ◽  
Lung Isolation ◽  
Significant Difference ◽  
Initial Placement ◽  
The Difference ◽  
Double Lumen Endobronchial Tube

Placing a double-lumen endobronchial tube (DLT) in an appropriate position to facilitate lung isolation is essential for thoracic procedures. The novel ANKOR DLT is a DLT developed with three cuffs with a newly added carinal cuff designed to prevent further advancement by being blocked by the carina when the cuff is inflated. In this prospective study, the direction and depth of initial placement of ANKOR DLT were compared with those of conventional DLT. Patients undergoing thoracic surgery (n = 190) with one-lung ventilation (OLV) were randomly allocated into either left-sided conventional DLT group (n = 95) or left-sided ANKOR DLT group (n = 95). The direction and depth of DLT position were compared via fiberoptic bronchoscopy (FOB) after endobronchial intubation between the groups. There was no significant difference in the number of right mainstem endobronchial intubations between the two groups (p = 0.468). The difference between the initial depth of DLT placement and the target depth confirmed by FOB was significantly lower in the ANKOR DLT group than in the conventional DLT group (1.8 ± 1.8 vs. 12.9 ± 9.7 mm; p < 0.001). In conclusion, the ANKOR DLT facilitated its initial positioning at the optimal depth compared to the conventional DLT.

scholarly journals Impact of normocapnic and permissive hypercapnic one-lung ventilation on arterial oxygenation

Critical Care ◽  
2011 ◽  
Vol 15 (S1) ◽  
Author(s):  
T Végh ◽  
Z Szabó-Maák ◽  
S Szatmári ◽  
J Hallay ◽  
I László ◽  
...  
Keyword(s):  
Lung Ventilation ◽  
Arterial Oxygenation ◽  
One Lung Ventilation

scholarly journals Effects of one-lung ventilation on thermodilution-derived assessment of cardiac output

2012 ◽  
Vol 108 (6) ◽  
pp. 922-928 ◽  
Author(s):  
C. Trepte ◽  
S. Haas ◽  
N. Meyer ◽  
M. Gebhardt ◽  
M.S. Goepfert ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Lung Ventilation ◽  
One Lung Ventilation
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