Almitrine Fails to Improve Oxygenation During One-Lung Ventilation With Sevoflurane Anesthesia

Bermejo, S.; Gallart, Lluís; Silva-Costa-Gomes, Teresa; Vallès, Jordi; Aguiló, Rafael; Puig, Margarita M.

doi:10.1053/j.jvca.2013.03.019

Cited by 9 publications

(4 citation statements)

References 30 publications

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“…Our study had a predetermined power of 0.8 and an alpha error of 0.05. SF had a standard deviation (SD) of 13% in a previous study [ 8 ]. With an SD of 13%, at least 27 patients were required in each study arm to detect a clinically significant difference of 10% in SF.…”

Section: Methodsmentioning

confidence: 99%

Effect of Deferasirox on Shunt Fraction During Thoracic Surgery With One-Lung Ventilation: A Randomized Controlled Study

Raman¹,

Nair²,

Siddiqui³

et al. 2023

Cureus

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Context Deferasirox, an iron chelator, can potentially reduce intraoperative right-to-left shunt and improve oxygenation in patients undergoing thoracic surgery requiring one-lung ventilation (OLV) by potentiating hypoxic pulmonary vasoconstriction (HPV). Aim The aim was to determine the effect of deferasirox on the intraoperative shunt fraction (SF) of patients undergoing thoracic surgery using OLV. Study design and settings This was a prospective, single-blind, randomized, controlled study. The study was conducted at a tertiary-care hospital. Methods Before surgery, 64 patients were allocated to two groups comprising 32 patients each. Group D patients were administered deferasirox, while those in group C were given a placebo. We included patients with the American Society of Anesthesiologists physical status III or IV, aged 18-60 years, undergoing elective thoracic surgery needing OLV. SF was the primary outcome variable. Secondary outcome variables were arterial oxygen tension (PaO 2 ), peripheral oxygen saturation (SpO 2 ), the ratio of PaO 2 and inspired oxygen concentration (P/F), and complications such as desaturation episodes, hypotension, and tachycardia. Results Baseline and postoperative values of outcome variables were statistically similar in both groups. Intraoperative values of SF were lower and PaO 2 , SpO 2 , and P/F were higher in group D. The incidence of intraoperative desaturation was lower in group D. Conclusion We conclude that pre-treatment with deferasirox reduces intraoperative SF and improves oxygenation during thoracic surgery using OLV.

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Section: Methodsmentioning

confidence: 99%

Effect of Deferasirox on Shunt Fraction During Thoracic Surgery With One-Lung Ventilation: A Randomized Controlled Study

Raman¹,

Nair²,

Siddiqui³

et al. 2023

Cureus

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“…A small clinical trial with almitrine (a drug formerly approved for treating COPD that has been shown to enhance the central ventilator response and HPV in animal models of ALI [155,156]) found that almitrine with or without iNO increased P aO 2 and improved perfusion redistribution in ARDS patients at low doses but increased PAP at higher doses [157,158]. Furthermore, in combination with inhalative anaesthesia, almitrine may fail to improve P aO 2 [159]. Oral almitrine was withdrawn from the market in 2013 because of its potential to cause peripheral neuropathy and weight loss (>15%) in patients after long-term use [160].…”

Section: Dysregulation Of Hpv In Sars-cov-2 Infectionmentioning

confidence: 99%

Impairment of hypoxic pulmonary vasoconstriction in acute respiratory distress syndrome

et al. 2021

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Acute respiratory distress syndrome (ARDS) is a serious complication of severe systemic or local pulmonary inflammation, such as caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. ARDS is characterised by diffuse alveolar damage that leads to protein-rich pulmonary oedema, local alveolar hypoventilation and atelectasis. Inadequate perfusion of these areas is the main cause of hypoxaemia in ARDS. High perfusion in relation to ventilation (V/Q<1) and shunting (V/Q=0) is not only caused by impaired hypoxic pulmonary vasoconstriction but also redistribution of perfusion from obstructed lung vessels. Rebalancing the pulmonary vascular tone is a therapeutic challenge. Previous clinical trials on inhaled vasodilators (nitric oxide and prostacyclin) to enhance perfusion to high V/Q areas showed beneficial effects on hypoxaemia but not on mortality. However, specific patient populations with pulmonary hypertension may profit from treatment with inhaled vasodilators. Novel treatment targets to decrease perfusion in low V/Q areas include epoxyeicosatrienoic acids and specific leukotriene receptors. Still, lung protective ventilation and prone positioning are the best available standard of care. This review focuses on disturbed perfusion in ARDS and aims to provide basic scientists and clinicians with an overview of the vascular alterations and mechanisms of V/Q mismatch, current therapeutic strategies, and experimental approaches.

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“…[ 72 ] In thoracic surgery, almitritine has been shown effective to attenuate the fall in PaO 2 during OLV under iv anesthesia but not under sevoflurane anesthesia. [ 73 74 75 ]…”

Section: Effects Of Patient Position Anesthetic Technique and Mechanical Ventilation In Gas Exchangementioning

confidence: 99%

The hypoxic pulmonary vasoconstriction: From physiology to clinical application in thoracic surgery

et al. 2021

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More than 70 years after its original report, the hypoxic pulmonary vasoconstriction (HPV) response continues to spark scientific interest on its mechanisms and clinical implications, particularly for anesthesiologists involved in thoracic surgery. Selective airway intubation and one-lung ventilation (OLV) facilitates the surgical intervention on a collapsed lung while the HPV redirects blood flow from the “upper” non-ventilated hypoxic lung to the “dependent” ventilated lung. Therefore, by limiting intrapulmonary shunting and optimizing ventilation-to-perfusion (V/Q) ratio, the fall in arterial oxygen pressure (PaO 2 ) is attenuated during OLV. The HPV involves a biphasic response mobilizing calcium within pulmonary vascular smooth muscles, which is activated within seconds after exposure to low alveolar oxygen pressure and that gradually disappears upon re-oxygenation. Many factors including acid-base balance, the degree of lung expansion, circulatory volemia as well as lung diseases and patient age affect HPV. Anesthetic agents, analgesics and cardiovascular medications may also interfer with HPV during the perioperative period. Since HPV represents the homeostatic mechanism for regional ventilation-to-perfusion matching and in turn, for optimal pulmonary oxygen uptake, a clear understanding of HPV is clinically relevant for all anesthesiologists.

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Almitrine Fails to Improve Oxygenation During One-Lung Ventilation With Sevoflurane Anesthesia

Cited by 9 publications

References 30 publications

Effect of Deferasirox on Shunt Fraction During Thoracic Surgery With One-Lung Ventilation: A Randomized Controlled Study

Effect of Deferasirox on Shunt Fraction During Thoracic Surgery With One-Lung Ventilation: A Randomized Controlled Study

Impairment of hypoxic pulmonary vasoconstriction in acute respiratory distress syndrome

The hypoxic pulmonary vasoconstriction: From physiology to clinical application in thoracic surgery

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