scholarly journals The Effects of Iloprost on Oxygenation During One-Lung Ventilation for Lung Surgery: A Randomized Controlled Trial

2019 ◽  
Vol 8 (7) ◽  
pp. 982 ◽  
Author(s):  
Hoon Choi ◽  
Joonpyo Jeon ◽  
Jaewon Huh ◽  
Jungmin Koo ◽  
Sungwon Yang ◽  
...  
Keyword(s):  
Perioperative Complications ◽  
Controlled Trial ◽  
Venous Blood ◽  
Lung Ventilation ◽  
Lung Surgery ◽  
Control Group ◽  
One Lung Ventilation ◽  
Arterial Blood ◽  
Pulmonary Vasodilator ◽  
Inhaled Iloprost

Hypoxemia can occur during one-lung ventilation (OLV) in thoracic surgery, leading to perioperative complications. Inhaled iloprost is a selective pulmonary vasodilator with efficacy in patients with pulmonary hypertension. The purpose of this study was to evaluate the effects of off-label inhaled iloprost on oxygenation during OLV in patients undergoing lung surgery. Seventy-two patients who were scheduled for elective video-assisted thoracoscopic lobectomy were assigned to receive an inhaled nebulizer of distilled water (control group), 10 μg iloprost (IL10 group), or 20 μg iloprost (IL20 group). Arterial and venous blood gas and hemodynamic analyses were obtained. Changes in partial pressure of oxygen in arterial blood (PaO2), after the initiation of OLV and the resumption two-lung ventilation (TLV), were similar in all three groups. However, PaO2 in the IL10 group was comparable to that in the control group, whereas PaO2 in the IL20 group was significantly higher than that in the control group at 10, 20, and 30 min after administration of iloprost (275.1 ± 50.8 vs. 179.3 ± 38.9, p < 0.0001; 233.9 ± 39.7 vs. 155.1 ± 26.5, p < 0.0001; and 224.6 ± 36.4 vs. 144.0 ± 22.9, p < 0.0001, respectively). The shunt fraction in the IL20 group was significantly higher than that in the control group after administration of iloprost (26.8 ± 3.1 vs. 32.2 ± 3.4, p < 0.0001; 24.6 ± 2.2 vs. 29.9 ± 3.4, p < 0.0001; and 25.3 ± 2.0 vs. 30.8 ± 3.1, p < 0.0001, respectively). Administration of inhaled iloprost during OLV improves oxygenation and decreases intrapulmonary shunt.

scholarly journals Which Anesthesia Regimen Is Best to Reduce Morbidity and Mortality in Lung Surgery?

2016 ◽  
Vol 125 (2) ◽  
pp. 313-321 ◽  
Author(s):  
Beatrice Beck-Schimmer ◽  
John M. Bonvini ◽  
Julia Braun ◽  
Manfred Seeberger ◽  
Thomas A. Neff ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Lung Ventilation ◽  
Hazard Ratio ◽  
Lung Surgery ◽  
One Lung Ventilation ◽  
Randomized Controlled ◽  
Major Complications ◽  
Multicenter Randomized Controlled Trial ◽  
Volatile Anesthesia

Abstract Background One-lung ventilation during thoracic surgery is associated with hypoxia–reoxygenation injury in the deflated and subsequently reventilated lung. Numerous studies have reported volatile anesthesia–induced attenuation of inflammatory responses in such scenarios. If the effect also extends to clinical outcome is yet undetermined. We hypothesized that volatile anesthesia is superior to intravenous anesthesia regarding postoperative complications. Methods Five centers in Switzerland participated in the randomized controlled trial. Patients scheduled for lung surgery with one-lung ventilation were randomly assigned to one of two parallel arms to receive either propofol or desflurane as general anesthetic. Patients and surgeons were blinded to group allocation. Time to occurrence of the first major complication according to the Clavien-Dindo score was defined as primary (during hospitalization) or secondary (6-month follow-up) endpoint. Cox regression models were used with adjustment for prestratification variables and age. Results Of 767 screened patients, 460 were randomized and analyzed (n = 230 for each arm). Demographics, disease and intraoperative characteristics were comparable in both groups. Incidence of major complications during hospitalization was 16.5% in the propofol and 13.0% in the desflurane groups (hazard ratio for desflurane vs. propofol, 0.75; 95% CI, 0.46 to 1.22; P = 0.24). Incidence of major complications within 6 months from surgery was 40.4% in the propofol and 39.6% in the desflurane groups (hazard ratio for desflurane vs. propofol, 0.95; 95% CI, 0.71 to 1.28; P = 0.71). Conclusions This is the first multicenter randomized controlled trial addressing the effect of volatile versus intravenous anesthetics on major complications after lung surgery. No difference between the two anesthesia regimens was evident.

scholarly journals Hipotenzinės epidurinės anestezijos įtaka šunto frakcijai

2007 ◽  
Vol 5 (3) ◽  
pp. 0-0
Author(s):  
Renatas Tikuišis ◽  
Povilas Miliauskas ◽  
Saulius Cicėnas ◽  
Aleksas Žurauskas ◽  
Narimantas Evaldas Samalavičius
Keyword(s):  
Blood Pressure ◽  
General Anesthesia ◽  
Epidural Anesthesia ◽  
Lung Ventilation ◽  
Control Group ◽  
Shunt Fraction ◽  
Pulmonary Shunt ◽  
One Lung Ventilation ◽  
Arterial Blood ◽  
Significant Difference

Renatas Tikuišis, Povilas Miliauskas, Saulius Cicėnas, Aleksas Žurauskas, Narimantas Evaldas SamalavičiusVilniaus universiteto Onkologijos institutas, Santariškių g. 1, LT-08660El paštas: [email protected] Įvadas / tikslas Vieno plaučio ventiliavimas padidina plautinį šuntą ir sumažina PaO2, nors ir ventiliacija atliekama 100% deguonimi. Šio tyrimo tikslas buvo palyginti šunto frakciją esant normaliam ir sumažintam kraujo spaudimui, kai atliekama abiejų ir vieno plaučio ventiliacija. Ligoniai ir metodai Tyrime dalyvavo 100 pacientų. Pacientai atsitiktine tvarka buvo suskirstyti į dvi grupes: tiriamąją (T grupė) ir kontrolinę (K grupė). Kiekvieną grupę sudarė po 50 pacientų. T grupės pacientams buvo taikyta torakalinė epidurinė ir bendroji intubacinė nejautra. Epidurinė nejautra naudota skausmui malšinti ir vidutiniam arteriniam kraujospūdžiui (VAS) sumažinti iki 50–60 mm Hg. K grupės pacientams taikyta tik bendroji intubacinė nejautra ir VAS nebuvo sumažintas (79–119 mm Hg). Arterinio ir veninio kraujo tyrimas buvo atliekamas ventiliuojant abu plaučius ir praėjus 20, 40, 60 minučių, kai buvo ventiliuojamas vienas plautis. Rezultatai Abi grupės pagal operacijos apimtį ir ligonių charakteristiką buvo vienodos. Plautinis šuntas padidėja pradėjus vieno plaučio ventiliaciją abiejų grupių ligoniams. Tačiau atskirų grupių plautinis šuntas nesiskiria tiek ventiliuojant vieną plautį, tiek ventiliuojant abu. Išvada Nei torakalinė epidurinė nejautra, nei mažas kraujo spaudimas nedidina plautinio šunto ventiliuojant vieną ar abu plaučius Pagrindiniai žodžiai: plautinis šuntas, plaučių ventiliacija The effect of hypotensive epidural anesthesia on shunt fraction Renatas Tikuišis, Povilas Miliauskas, Saulius Cicėnas, Aleksas Žurauskas, Narimantas Evaldas SamalavičiusVilnius University, Institute of Oncology, Santariškių str. 1, LT-08660 Vilnius, LithuaniaE-mail: [email protected] Objective One-lung ventilation (OLV) induces an increase in pulmonary shunt sometimes associated with a decrease in PaO2 despite ventilation with 100% oxygen. The aim of the study was to compare shunt fraction during two and one lung ventilation in patients with normal and decreased blood pressure. Patients and methods One hundred patients were enrolled in this study. Patients were randomly assigned to one of the two groups: investigation (group T) and control (group K). Fifty patients were involved in group T. Thoracic epidural anesthesia (TEA) combined with general anesthesia was used in these patients. TEA was used to reach analgesia and to reduce mean arterial blood pressure (MAP) to 50–60 mmHg. Group K also covered 50 patients. Only general anesthesia was used in these patients and MAP was not reduced (it was 79–119 mmHg). Arterial and venous blood samples were measured at the end of two lung ventilations, 20, 40 and 60 min after the initiation of OLV. Results There were no significant differences in the type of operation and preoperative patients’ characteristics between the groups. In both groups, the pulmonary shunt fraction increased significantly during OLV in comparison to two-lung ventilation (TLV), but there was no significant difference between the groups as regards shunt fraction during OLV or TLV. Conclusion We concluded that TEA and reduced MAP do not significantly influence shunt fraction during two- and one-lung ventilation. Keywords: pulmonary shunt, lung ventilation

scholarly journals A randomised controlled trial on roles of prostaglandin E1 nebulization among patients undergoing one lung ventilation

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Pengyi Li ◽  
Lianbing Gu ◽  
Jing Tan ◽  
Zhenghuan Song ◽  
Qingming Bian ◽  
...  
Keyword(s):  
Prostaglandin E1 ◽  
Controlled Trial ◽  
Lung Ventilation ◽  
Inflammatory Factors ◽  
Pulmonary Shunt ◽  
One Lung Ventilation ◽  
Reference Concentration ◽  
Group A ◽  
Group B ◽  
Randomised Controlled

Abstract Background Prostaglandin E1 (PGE1) has been reported to maintain adequate oxygenation among patients under 60% FiO2 one-lung ventilation (OLV). This research aimed to explore whether PGE1 is safe in pulmonary shunt and oxygenation under 40% FiO2 OLV and provide a reference concentration of PGE1. Methods Totally 90 esophageal cancer patients treated with thoracotomy were enrolled in this study, randomly divided into three groups (n = 30/group): Group A (60% FiO2 and 0.1 µg/kg PGE1), Group B (40% FiO2 and 0.1 µg/kg PGE1), and Group C (40% FiO2, 0.2 µg/kg PGE1). Primary outcomes were oxygenation and pulmonary shunt during OLV. Secondary outcomes included oxidative stress after OLV. Results During OLV, patients in Group C and B had lower levels of PaO2, SaO2, SpO2, MAP, and Qs/Qt than those in Group A (P < 0.05). At T2 (OLV 10 min), patients in Group C and B exhibited a lower level of PaO2/FiO2 than those in Group A, without any statistical difference at other time points. The IL-6 levels of patients in different groups were different at T8 (F = 3.431, P = 0.038), with IL-6 in Group C being lower than that in Group B and A. MDA levels among the three groups differed at T5 (F = 4.692, P = 0.012) and T7 (F = 5.906, P = 0.004), with the MDA level of Group C being lower than that of Group B and A at T5, and the MDA level of Group C and B being lower than that of Group A at T7. In terms of TNF-α level, patients in Group C had a lower level than those in Group B and A at T8 (F = 3.598, P = 0.033). Compared with patients who did not use PGE1, patients in Group C had comparable complications and lung infection scores. Conclusion The concentration of FiO2 could be reduced from 60 to 40% to maintain oxygenation. 40% FiO2 + 0.2 µg/kg PGE1 is recommended as a better combination on account of its effects on the inflammatory factors. Trial registration: Chictr.org.cn identifier: ChiCTR1800018288, 09/09/2018.

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 &lt; 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 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.

The effect of hypercapnia and hypertension on cerebral oxygen balance during one-lung ventilation for lung surgery during propofol anesthesia

2010 ◽  
Vol 22 (8) ◽  
pp. 608-613 ◽  
Author(s):  
Masato Iwata ◽  
Satoki Inoue ◽  
Masahiko Kawaguchi ◽  
Michitaka Kimura ◽  
Takashi Tojo ◽  
...  
Keyword(s):  
Lung Ventilation ◽  
Lung Surgery ◽  
Cerebral Oxygen ◽  
Oxygen Balance ◽  
One Lung Ventilation ◽  
Cerebral Oxygen Balance

scholarly journals Effects of Dexmedetomidine Infusion on Inflammatory Responses and Injury of Lung Tidal Volume Changes during One-Lung Ventilation in Thoracoscopic Surgery: A Randomized Controlled Trial

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Chun-Yu Wu ◽  
Yi-Fan Lu ◽  
Man-Ling Wang ◽  
Jin-Shing Chen ◽  
Yen-Chun Hsu ◽  
...  
Keyword(s):  
Tidal Volume ◽  
Inflammatory Responses ◽  
Thoracoscopic Surgery ◽  
Controlled Trial ◽  
Lung Ventilation ◽  
Saline Group ◽  
Medical Complication ◽  
Volume Changes ◽  
One Lung Ventilation ◽  
Monocyte Chemoattractant Protein 1

One-lung ventilation in thoracic surgery provokes profound systemic inflammatory responses and injury related to lung tidal volume changes. We hypothesized that the highly selective a2-adrenergic agonist dexmedetomidine attenuates these injurious responses. Sixty patients were randomly assigned to receive dexmedetomidine or saline during thoracoscopic surgery. There is a trend of less postoperative medical complication including that no patients in the dexmedetomidine group developed postoperative medical complications, whereas four patients in the saline group did (0% versus 13.3%,p=0.1124). Plasma inflammatory and injurious biomarkers between the baseline and after resumption of two-lung ventilation were particularly notable. The plasma high-mobility group box 1 level decreased significantly from 51.7 (58.1) to 33.9 (45.0) ng.ml−1(p<0.05) in the dexmedetomidine group, which was not observed in the saline group. Plasma monocyte chemoattractant protein 1 [151.8 (115.1) to 235.2 (186.9) pg.ml−1,p<0.05] and neutrophil elastase [350.8 (154.5) to 421.9 (106.1) ng.ml−1,p<0.05] increased significantly only in the saline group. In addition, plasma interleukin-6 was higher in the saline group than in the dexmedetomidine group at postoperative day 1 [118.8 (68.8) versus 78.5 (58.8) pg.ml−1,p=0.0271]. We conclude that dexmedetomidine attenuates one-lung ventilation-associated inflammatory and injurious responses by inhibiting alveolar neutrophil recruitment in thoracoscopic surgery.

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