We investigated the haemodynamic and respiratory effects of one‐lung ventilation and carbon dioxide insufflation in 13 adult patients undergoing video‐assisted thoracoscopy. Cardiorespiratory variables were determined during carbon dioxide insufflation at intrahemithoracic pressures of 5, 10 and 15 mmHg, and after 5 and 15 min of one‐lung ventilation. Carbon dioxide insufflation was associated with a clear deterioration in circulatory function. The cardiac index decreased subsequent to increasing intrathoracic pressures. The mean cardiac index (SD) at pressures of 10 and 15 mmHg was 1.86 (0.39) and 1.52 (0.46), respectively, and may be compared with the reduced venous return consistent with tension pneumothorax. One‐lung ventilation did not affect haemodynamic variables but reduced arterial oxygenation indices (Pao2/FIo2) from 424.29 (160.79) after induction of anaesthesia, to 207.72 (125.50) after 5 min and 172.04 (72.03) after 15 min of one‐lung ventilation, respectively. The oxygenation index was not influenced by intrahemithoracic carbon dioxide insufflation. One‐lung ventilation via a double‐lumen endobronchial tube is safe and convenient for video‐assisted thoracoscopic surgery. It has no further consequences on haemodynamic variables, whereas the compression of the lung by carbon dioxide insufflation may cause circulatory dysfunction.
1. A comparison has been made between the effect of various forms of P.M.S. on the cow's ovaries by giving 3000 i.u. of: (a) processed P.M.S., (b) fresh whole P.M.S., (c) freeze-dried P.M.S.; the average follicle numbers produced being 13·9, 20·1, and 14·5 respectively.
In 1886 Sir Norman Moore in his biography of James Douglas in the Dictionary of National Biography remarked that "when the first living authority on midwifery in London, the latest writer on the peritoneum and two of the best known teachers of anatomy were asked where Douglas's description of the peritoneum was to be found, none knew nor whether it was he or his brother the surgeon who they daily commemorated." Since then the situation should have been improved by Bryn Thomas
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