Room B, 10/17/2000 9: 00 AM - 11: 00 AM (PS) Does the Administration of Thoracic Epidural Lidocaine Affect Oxygenation during Anesthesia for One-Lung Ventilation (OLV) in Patients Undergoing Thoracic Surgery? 

2000 ◽  
Vol 93 (3A) ◽  
pp. A-149
Author(s):  
J. H. Campos ◽  
T. J. Brennan ◽  
C. F. Massa ◽  
K. H. Kernstine
Keyword(s):  
Thoracic Surgery ◽  
Lung Ventilation ◽  
One Lung Ventilation ◽  
Thoracic Epidural

scholarly journals May awake video-assisted thoracoscopic surgery with thoracic epidural anesthesia use routinely for minimaly invasive thoracic surgery procedures in the future?

2018 ◽  
Vol 5 (5) ◽  
pp. 1602
Author(s):  
Gonul Sagiroglu ◽  
Fazli Yanik ◽  
Yekta A. Karamusfaoglu ◽  
Elif Copuroglu
Keyword(s):  
Thoracic Surgery ◽  
General Anesthesia ◽  
Epidural Anesthesia ◽  
Thoracoscopic Surgery ◽  
Lung Ventilation ◽  
Thoracic Epidural Anesthesia ◽  
One Lung Ventilation ◽  
Thoracic Epidural ◽  
Video Assisted ◽  
Video Assisted Thoracoscopic Surgery

Background: In the last years thoracic surgery developed in greater extent with equipments and techniques in one lung ventilation. Still general anesthesia in one lung ventilation approved as gold standard. In thoracic surgery most performed surgeries are plerural decortication and lung biopsy. Avoidance of intubation in Video Assisted Thoracoscopic Surgery (VATS) procedures gains us some advantages in postoperative period; a better respiratory parameters, survival and morbidity mortality rates, reduced hospitalization time and costs, reduced early stress hormone and immune response.  Methods: In this study, we reported our experience of 24 consecutive patients undergoing VATS with Thoracic Epidural Anesthesia (TEA) between December 2015 through July 2016 to evaluate the feasibility, safety and indication of this innovative technique whether it will be a gold standart in thoracic surgeries or not in the future.Results: Operation procedures included wedge resection in 11 (46%) patients (eight of them for pneumothorax, three of them for diagnosis), in 10 (42%) patients pleural biopsy (eight of them used talc pleurodesis), in two (8%) patients air leak control with fibrin glue and in one (4%) patient bilateral thoracal sympathectomy for hyperhidrosis.  We used T4-5 TEA space for 17 (72%) of patients, while we used T4-6 TEA space for 7 (28%) of patients. TEA block reached the desired level after the mean 26.4±4.3 minutes (range 21-34 min). There was no occurrence of hypotension and bradycardia during and after TEA. One (4%) patient required conversion to general anesthesia and tracheal intubation because of significant diaphragmatic contractions and hyperpne. Conversion to thoracotomy was not needed in any patient.Conclusions: We conclude that nVATS procedure with aid of TEA is feasibile and safety with minimal adverse events. The procedure can have such advantages as early mobilization, opening of early oral intake, early discharge, patient satisfaction, low pain level. Nevertheless, there is a need for randomized controlled trials involving wider case series on the subject.

Effects of thoracic epidural meperidine on arterial oxygenation during one-lung ventilation in thoracic surgery

2003 ◽  
Vol 17 (3) ◽  
pp. 302-305 ◽  
Author(s):  
Ignacio Garutti ◽  
Patricia Cruz ◽  
Luis Olmedilla ◽  
Jose Marı́a Barrio ◽  
Alberto Cruz ◽  
...  
Keyword(s):  
Thoracic Surgery ◽  
Lung Ventilation ◽  
Arterial Oxygenation ◽  
One Lung Ventilation ◽  
Thoracic Epidural

scholarly journals Effect of Thoracic Epidural Anesthesia with Different Concentrations of Ropivacaine on Arterial Oxygenation during One-lung Ventilation

2010 ◽  
Vol 112 (5) ◽  
pp. 1146-1154 ◽  
Author(s):  
Yajun Xu ◽  
Zhiming Tan ◽  
Shilai Wang ◽  
Haijun Shao ◽  
Xuqin Zhu
Keyword(s):  
Epidural Anesthesia ◽  
Arterial Oxygen Tension ◽  
Lung Ventilation ◽  
Saline Group ◽  
Lung Surgery ◽  
Thoracic Epidural Anesthesia ◽  
Arterial Oxygen ◽  
One Lung Ventilation ◽  
Thoracic Epidural ◽  
Double Blinded

Background Thoracic epidural anesthesia can contribute to facilitate the fast-track approach in lung surgery. However, data regarding the effects of thoracic epidural anesthesia on oxygenation during one-lung ventilation (OLV) are scarce and contradictory. Therefore, the authors conducted a prospective, randomized, double-blinded trial in patients undergoing lung surgery under spectral entropy-guided intravenous anesthesia to evaluate the effects of thoracic epidural anesthesia with different concentrations of ropivacaine on oxygenation, shunt fraction (Qs/Qt) during OLV, and maintenance doses of propofol. Methods One hundred twenty patients scheduled for lung surgery were randomly divided into four groups to epidurally receive saline (Group S), 0.25% (Group R0.25), 0.50% (Group R0.50), and 0.75% (Group R0.75) ropivacaine. Ropivacaine was administered intraoperatively (6-8 ml of first bolus + 5 ml/h infusion). Arterial oxygen tension (Pao2) and Qs/Qt were measured before, during, and after OLV. Results Pao2 was significantly lower in Group R0.75 compared with that in Group S and Group R0.25 10 min (170 +/- 61 vs. 229 +/- 68 mmHg, P = 0.01; 170 +/- 61 vs. 223 +/- 70 mmHg, P = 0.03) and 20 min after OLV (146 +/- 52 vs. 199 +/- 68 mmHg, P = 0.009; 146 +/- 52 vs. 192 +/- 67 mmHg, P = 0.03). During OLV, Qs/Qt was significantly higher in Group R0.75 compared with that in Group S and Group R0.25 (P < 0.05). Maintenance doses of propofol were significantly lower in Group R0.75. Vasopressor requirements were higher in Group R0.75. Conclusion A decrease in oxygenation during OLV occurred only at the highest dose of epidural local anesthetic and not at lower doses. Higher doses of epidural medication required less propofol and more vasopressors.

scholarly journals Driving Pressure during Thoracic Surgery

2019 ◽  
Vol 130 (3) ◽  
pp. 385-393 ◽  
Author(s):  
MiHye Park ◽  
Hyun Joo Ahn ◽  
Jie Ae Kim ◽  
Mikyung Yang ◽  
Burn Young Heo ◽  
...  
Keyword(s):  
Thoracic Surgery ◽  
Tidal Volume ◽  
Odds Ratio ◽  
Lung Ventilation ◽  
Pulmonary Complications ◽  
Protective Ventilation ◽  
Driving Pressure ◽  
Pressure Group ◽  
Postoperative Pulmonary Complications ◽  
One Lung Ventilation

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Recently, several retrospective studies have suggested that pulmonary complication is related with driving pressure more than any other ventilatory parameter. Thus, the authors compared driving pressure–guided ventilation with conventional protective ventilation in thoracic surgery, where lung protection is of the utmost importance. The authors hypothesized that driving pressure–guided ventilation decreases postoperative pulmonary complications more than conventional protective ventilation. Methods In this double-blind, randomized, controlled study, 292 patients scheduled for elective thoracic surgery were included in the analysis. The protective ventilation group (n = 147) received conventional protective ventilation during one-lung ventilation: tidal volume 6 ml/kg of ideal body weight, positive end-expiratory pressure (PEEP) 5 cm H2O, and recruitment maneuver. The driving pressure group (n = 145) received the same tidal volume and recruitment, but with individualized PEEP which produces the lowest driving pressure (plateau pressure–PEEP) during one-lung ventilation. The primary outcome was postoperative pulmonary complications based on the Melbourne Group Scale (at least 4) until postoperative day 3. Results Melbourne Group Scale of at least 4 occurred in 8 of 145 patients (5.5%) in the driving pressure group, as compared with 18 of 147 (12.2%) in the protective ventilation group (P = 0.047, odds ratio 0.42; 95% CI, 0.18 to 0.99). The number of patients who developed pneumonia or acute respiratory distress syndrome was less in the driving pressure group than in the protective ventilation group (10/145 [6.9%] vs. 22/147 [15.0%], P = 0.028, odds ratio 0.42; 95% CI, 0.19 to 0.92). Conclusions Application of driving pressure–guided ventilation during one-lung ventilation was associated with a lower incidence of postoperative pulmonary complications compared with conventional protective ventilation in thoracic surgery.

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