A Comparison of the Effects of Isoflurane Verus Propofol Anesthesia on Blood Gas Parameters during One Lung Ventilation for Lung Surgery

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.

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The Comparative Study of the Single-lumen Tube and Double-lumen Tube in the Blood Gas Analysis for One-lung Ventilation

Korean Journal of Anesthesiology ◽

10.4097/kjae.1994.27.4.381 ◽

1994 ◽

Vol 27 (4) ◽

pp. 381

Author(s):

Su Won Kim ◽

Byung Young Kim ◽

Myoung Hoon Kong ◽

Hae Ja Lim ◽

Byung Kook Chae ◽

...

Keyword(s):

Lung Ventilation ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Double Lumen Tube ◽

Blood Gas ◽

One Lung Ventilation ◽

Double Lumen ◽

Lumen Tube ◽

Single Lumen ◽

The Comparative Study

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

Journal of Clinical Anesthesia ◽

10.1016/j.jclinane.2010.05.006 ◽

2010 ◽

Vol 22 (8) ◽

pp. 608-613 ◽

Cited By ~ 1

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

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Jugular Bulb Venous Oxygen Saturation During One-Lung Ventilation Under Sevoflurane- or Propofol-Based Anesthesia for Lung Surgery

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2007.03.012 ◽

2008 ◽

Vol 22 (1) ◽

pp. 71-76 ◽

Cited By ~ 23

Author(s):

Masato Iwata ◽

Satoki Inoue ◽

Masahiko Kawaguchi ◽

Makoto Takahama ◽

Takashi Tojo ◽

...

Keyword(s):

Oxygen Saturation ◽

Lung Ventilation ◽

Jugular Bulb ◽

Lung Surgery ◽

One Lung Ventilation ◽

Venous Oxygen Saturation

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Cerebral Oxygen Desaturation in Patients with Totally Thoracoscopic Ablation for Atrial Fibrillation

10.21203/rs.2.42/v1 ◽

2018 ◽

Author(s):

Guohui Li ◽

Sai’e Shen ◽

Liqiao Yang ◽

Yuan Sun ◽

Xueyin Shi

Keyword(s):

Atrial Fibrillation ◽

Linear Regression ◽

Pulmonary Vein ◽

Lung Ventilation ◽

Multivariate Linear Regression ◽

Oxygen Desaturation ◽

Cerebral Oxygen ◽

Blood Gas ◽

Pulmonary Vein Ablation ◽

Blood Gas Parameters

Abstract Background: Epicardial radiofrequency ablation for atrial fibrillation under total video-assisted thoracoscopy causes severe cardiopulmonary disturbances and affects cerebral perfusion and oxygenation. The aim of the present study was to investigate the changes in regional cerebral oxygen saturation (rSO2) during the surgery and their correlations with hemodynamic or blood gas parameters. Methods: A total of 45 patients scheduled for selective totally thoracoscopic ablation for stand-alone atrial fibrillation were enrolled in this study. The rSO2 was monitored at baseline (T0), 15 min after anesthesia induction (T1), 15 min after one-lung ventilation (T2), after right pulmonary vein ablation (T3), after left pulmonary vein ablation (T4) and 15 min after two-lung ventilation (T5) using a near-infrared reflectance spectroscopy (NIRS)-based cerebral oximeter. A Swan-Ganz catheter was placed in the pulmonary artery to obtain hemodynamic parameters. Arterial blood gas was analyzed using an ABL 825 hemoximeter. Associations between changes in rSO2 (△rSO2) and hemodynamic or blood gas parameters were determined with univariate and multivariate linear regression analyses. Results: The rSO2 decreased greatly from baseline 65.3% to 57.5% at T3 (P < 0.001). Univariate analysis showed that △rSO2 correlated significantly with △pH (r = -0.371, P = 0.012), △PaCO2 (r = -0.276, P = 0.066), △PaO2/FiO2 (r = 0.332, P = 0.026), △HR (r = 0.27, P = 0.073), △CI (r = -0.228, P = 0.132) and △PVRI/SVRI (r = -0.216, P = 0.153). Multivariate linear regression analysis further showed that △rSO2 was only influenced by △PaO2/FiO2 (β = 0.026, P = 0.025). Conclusion: The rSO2 decreased significantly during the totally thoracoscopic ablation for atrial fibrillation. There was a correlation between rSO2 reduction and PaO2/FiO2 changes. Greater attention should be paid to cerebral oxygen desaturation during the surgery.

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

Journal of Clinical Medicine ◽

10.3390/jcm8070982 ◽

2019 ◽

Vol 8 (7) ◽

pp. 982 ◽

Cited By ~ 3

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.

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