A Comparison of Effects of Propofol and Isoflurane on Arterial Oxygenation Pressure, Mean Arterial Pressure and Heart Rate Variations Following One-Lung Ventilation in Thoracic Surgeries

Attar, Alireza Sharifian; Tabari, Masoomeh; Rahnamazadeh, Mohammadreza; Salehi, Maryam

doi:10.5812/ircmj.15809

Cited by 9 publications

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“…Propofol improved oxygenation and shunt fraction during OLV compared to sevoflurane anesthesia in patients undergoing esophagectomy [6] or thoracotomy pulmonary lobectomy [27]. In other studies, propofol anesthesia did not differ in changes in shunt fraction or oxygenation during OLV for thoracic surgery in comparison with sevoflurane or isoflurane [7–10]. Moreover, arterial oxygenation was not different between propofol-alfentanil vs. isoflurane anesthesia during OLV in patients undergoing thoracoscopic pulmonary surgery or esophageal surgery [26].…”

Section: Discussionmentioning

confidence: 99%

Effect of desflurane-remifentanil vs. Propofol-remifentanil anesthesia on arterial oxygenation during one-lung ventilation for thoracoscopic surgery: a prospective randomized trial

et al. 2017

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BackgroundOne-lung ventilation during thoracic surgery frequently disturbs normal systemic oxygenation. However, the effect of anesthetics on arterial oxygenation during one-lung ventilation has not been well established in human study. In this clinical trial, we investigated whether a difference between desflurane-remifentanil and propofol-remifentanil anesthesia can be observed with regard to oxygenation during one-lung ventilation for thoracoscopic surgery.MethodsAdult patients with lung cancer, scheduled for video-assisted thoracoscopic lobectomy without preoperative oxygen support, were screened and randomized to receive desflurane or propofol, with remifentanil continuous infusion in both groups. Mechanical ventilation was performed with tidal volume of 8 ml/kg and FIO2 0.5 during two-lung ventilation, and 6 ml/kg and 1.0 during one-lung ventilation, both with positive end-expiratory pressure of 5 cmH2O. Arterial blood gas analysis was performed preoperatively, during two-lung ventilation, and after 15, 30, 45, and 60 min of one-lung ventilation. The primary endpoint was PaO2 at 30 min after initiating one-lung ventilation. Statistical analyses included the independent t-test for the primary endpoint and a mixed model with a post-hoc analysis to evaluate the serial changes in values.ResultsPatients were recruited between July 9 and December 2, 2014. In total, 103 patients were analyzed (n = 52 in desflurane group and n = 51 in propofol group). The primary endpoint, PaO2 at 30 min of one-lung ventilation was lower in the desflurane group than the propofol group (170 ± 72 vs. 202 ± 82 mmHg; p = 0.039). Serial changes in PaO2 during one-lung ventilation showed lower levels during desflurane anesthesia compared with propofol anesthesia (mean difference, 45 mmHg; 95% confidence interval, 16–75 mmHg; p = 0.003).ConclusionsIn conclusion, desflurane-remifentanil anesthesia resulted in decreased arterial oxygenation compared with that of propofol-remifentanil anesthesia during one-lung ventilation for thoracoscopic surgery in patients with lung cancer.Trial registrationClinicalTrials.gov identifier: NCT02191371, registered on July 7, 2014

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Section: Discussionmentioning

confidence: 99%

Effect of desflurane-remifentanil vs. Propofol-remifentanil anesthesia on arterial oxygenation during one-lung ventilation for thoracoscopic surgery: a prospective randomized trial

et al. 2017

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“…The degree of hypoxemia during OLV is mainly influenced by the increase in the shunt and dead space ( 4 ). In fact, pulmonary arteriovenous fistula due to the presence of unsaturated blood is the most important cause of hypoxemia during OLV; hypoxic pulmonary vasoconstriction (HPV) is the major physiological defense mechanism against shunting ( 5 , 6 ). Based on this mechanism, pulmonary perfusion deviates from the unvented area to the ventilated area of the lung, and thus the unsaturated blood shunt is reduced and the hypoxemia is improved ( 5 – 7 ).…”

Section: Introductionmentioning

confidence: 99%

“…In fact, pulmonary arteriovenous fistula due to the presence of unsaturated blood is the most important cause of hypoxemia during OLV; hypoxic pulmonary vasoconstriction (HPV) is the major physiological defense mechanism against shunting ( 5 , 6 ). Based on this mechanism, pulmonary perfusion deviates from the unvented area to the ventilated area of the lung, and thus the unsaturated blood shunt is reduced and the hypoxemia is improved ( 5 – 7 ). Various factors such as temperature, acidity, airway pressure, patient position and cardiac outflow are effective on the HPV inhibitory effect ( 8 , 9 ).…”

Section: Introductionmentioning

confidence: 99%

“…The two main drug categories for the maintenance of anesthesia, including propofol (intravenous) and isoflurane (inhalational), are relatively new anesthetics that have rapid onset and offset due to low blood/gas partition coefficient and context-sensitive half-life. However, their effect on HPV and subsequently on partial pressures of oxygen (PaO2), carbon dioxide (PaCO2), and end-tidal carbon dioxide (ETCO2) has not yet been well studied ( 2 , 5 , 6 , 12 ). Although it seems that the vasoconstrictive effect of inhalational anesthetics can affect the protective role of HPV and may interfere with the oxygenation during the OLV, the recent studies on the effect of inhalational and intravenous anesthetics on PaO2 have revealed contradictory findings (5, 13 and 14).…”

Section: Introductionmentioning

confidence: 99%

“…Although it seems that the vasoconstrictive effect of inhalational anesthetics can affect the protective role of HPV and may interfere with the oxygenation during the OLV, the recent studies on the effect of inhalational and intravenous anesthetics on PaO2 have revealed contradictory findings (5, 13 and 14). The majority of studies compared sevoflurane with propofol ( 12 – 17 ); and limited researches compared the effect of isoflurane with propofol ( 5 , 18 , 19 ). In three studies comparing the effects of propofol and isoflurane, although the findings from two studies ( 5 , 20 ) found no difference in the effect of these two drugs, another study ( 19 ) revealed that isoflurane and desflurane reduced arterial oxygen pressure in animal models.…”

Section: Introductionmentioning

confidence: 99%

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Effect of propofol and isoflurane on gas exchange parameters following one-lung ventilation in thoracic surgery: a double-blinded randomized controlled clinical trial

et al. 2018

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BackgroundThe use of anesthetic drugs with minimal inhibitory effects on the hypoxic pulmonary vasoconstriction (HPV) could have a decisive role in preventing the hypoxemia during one-lung ventilation (OLV).ObjectiveThe aim of this study was to compare the effects of propofol and isoflurane on the changes in gas exchange parameters following OLV in thoracic surgery.MethodsThis double-blinded randomized controlled clinical trial was conducted on patients who were candidates for elective right thoracotomy referred to the central operating room of Ghaem Hospital in Mashhad, Iran, during February 2016–2017. Patients with age range of 18 to 75 years, class I and II American Society of Anesthesiologists (ASA) and thoracotomy with OLV for pulmonary resection or cyst drainage were included. The patients were randomly allocated (1:1 ratio) into two groups of propofol (P, 50–100μg/kg/min) and isoflurane (I, 1 minimum alveolar concentration (MAC) 1.1%). Partial pressure of carbon dioxide (PaCO2), partial pressure of oxygen (PaO2), end-tidal carbon dioxide (ETCO2) and arterial oxygen saturation (SPO2) were recorded before and 15 minutes after OLV and compared between the two groups. The comparison of the mean gas exchange parameters before and 15 minutes after OLV was performed using Mann-Whitney test in SPSS version 19 software. P<0.05 was considered statistically significant.ResultsIn this study, 122 patients with mean age of 59.4±14.1 years (two groups of 61) were studied. Both groups were matched for age or gender. The two groups had no significant difference in the gas exchange parameters before the OLV. Only PaCO2 (p=0.001) and ETCO2 (p=0.001) were significantly higher in the propofol group after 15 minutes OLV than in the isoflurane group. However, PaO2 (p=0.67), O2Sat (p=0.333) and PaCO2-ETCO2 gradient (p=0.809) showed no significant difference between the two groups at this minute.ConclusionBased on the results of this study, the propofol or isoflurane selection seems to have no significant effect on the arterial oxygenation. On the other hand, isoflurane and propofol could be an appropriate anesthetic for thoracic surgery by normalizing the carbon dioxide gradient range during the OLV.Clinical Trial RegistrationThe study was also registered at the Iranian Registry of Clinical Trials (IRCT2015123013159N8).FundingThe study was financially supported by the Deputy of Research of Mashhad University of Medical Sciences (grant number: 940119).

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Troubleshooting One-Lung Ventilation

Shafiepour

2019

Principles and Practice of Anesthesia for Thoracic Surgery

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A Comparison of Effects of Propofol and Isoflurane on Arterial Oxygenation Pressure, Mean Arterial Pressure and Heart Rate Variations Following One-Lung Ventilation in Thoracic Surgeries

Cited by 9 publications

References 15 publications

Effect of desflurane-remifentanil vs. Propofol-remifentanil anesthesia on arterial oxygenation during one-lung ventilation for thoracoscopic surgery: a prospective randomized trial

Effect of desflurane-remifentanil vs. Propofol-remifentanil anesthesia on arterial oxygenation during one-lung ventilation for thoracoscopic surgery: a prospective randomized trial

Effect of propofol and isoflurane on gas exchange parameters following one-lung ventilation in thoracic surgery: a double-blinded randomized controlled clinical trial

Troubleshooting One-Lung Ventilation

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