Arterial Oxygenation During One-Lung Ventilation

Garutti, Ignacio; Aramayona, Begoña; Olmedilla, Luis; Cruz, Angelines; Barranco, Mónica; Lucas, E. Garcia De

doi:10.1097/00000539-199903000-00005

Cited by 29 publications

(13 citation statements)

References 14 publications

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“…1 ). A total of 653 patients with 60 separate comparisons met all inclusion criteria [ 5 , 6 , 8 – 19 ] (Table 1 ). These reports were published between 1999 and 2010 and reported data were from 653 patients.…”

Section: Resultsmentioning

confidence: 99%

The effects of thoracic epidural analgesia on oxygenation and pulmonary shunt fraction during one-lung ventilation: an meta-analysis

Tan

Wang

et al. 2015

BMC Anesthesiol

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BackgroundThe aim of our study is to compare the effects of thoracic epidural analgesia combined with general anesthesia (GA) vs. general anesthesia on oxygenation and pulmonary shunt fraction during one-lung ventilation (OLV).MethodsLiterature research was firstly conducted for studies related to comparison of epidural anesthesia combined with GA vs. GA with reporting of hemodynamic and oxygenation variables and published from Jan 1990 to Jan 2014 in EMBAS, MEDLINE and Cochrane Central Register of Controlled Trials databases. The studies were reviewed and data were extracted and analyzed using fixed-effect and random-effect models.ResultsThere are 14 trials with 60 separate comparisons enrolling 653 patients for analysis. Regarding systemic hemodynamics, thoracic epidural analgesia decreased the mean arterial pressure and mean pulmonary arterial pressure with weighted mean difference 95 % confidence interval (−6.64 [−9.57 to −3.71] vs. -6.33 [−9.25 to −3.41] and −3.18 [−5.07 to −1.28] vs. -2.05 [−3.35 to −0.75]) respectively at the two measurements time, however, only decreasing heart rate and systemic vascular resistance (−3.28 [−5.98 to −0.67] and −319.99 [−447.05 to −192.94]) over the first 30 min after OLV. For oxygenation variables, thoracic epidural analgesia is associated with significant reduction in partial arterial oxygen pressure, mixed arterial saturation of oxygenation and increased pulmonary venous admixture fraction compared to general anesthesia with weighted mean difference 95 % confidence interval (−16.52 [−21.98 to − 11.05] vs. − 14.23 [−20.81 to − 7.65]), (0.74 [0.33 to 1.15] vs. − 0.63 [−1.23 to −0.04]) and (2.53 [1.35 to 3.72] vs. 2.77 [1.81 to 3.74]) respectively before and after 30 min of one-lung ventilation. A decrease in mixed venous saturation of oxygenation occurred after 30 min of OLV (−2.39 [−3.73 to −0.99]). Besides, a higher mean value of airway pressure was found in the thoracic epidural analgesia with weighted mean difference 95 % confidence interval (1.95 [1.61 to 2.28] vs. 0.87 [0.54 to 1.20]) at the measurements.ConclusionBased on the existing limited data puts forward recommendations for cautious usage of thoracic epidural analgesia in case of underlying risks in lower systemic hemodynamics, decreased partial arterial oxygen pressure but increases pulmonary shunt during one-lung ventilation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-015-0142-5) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

The effects of thoracic epidural analgesia on oxygenation and pulmonary shunt fraction during one-lung ventilation: an meta-analysis

Tan

Wang

et al. 2015

BMC Anesthesiol

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“…[123151617] However, a study by Ozcan et al . has well established that epidural has little or no effect on the HPV.…”

Section: Discussionmentioning

confidence: 99%

“…However, this technique has been validated and used in many earlier studies. [11832] Both left and right thoracotomies and multiple lung pathologies were included in the study. Designing a study in patients with similar pathologies and a single sided thoracotomy may bring out more accurate results.…”

Section: Discussionmentioning

confidence: 99%

“…However, sympathetic blockade caused by local anesthetics given epidurally may cause attenuation of hypoxic pulmonary vasoconstriction (HPV) leading to increase of shunt fraction and impairment of oxygenation. [1] Further, various adjuvants added to epidural local anesthetic for improving analgesia may also influence the HPV. [234] Dexmedetomidine; an alpha-2 agonist, may have possible favorable effects on HPV leading to better oxygenation.…”

Section: Introductionmentioning

confidence: 99%

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The effect of epidural dexmedetomidine on oxygenation and shunt fraction in patients undergoing thoracotomy and one lung ventilation: A randomized controlled study

Kar

Durga

Ramachandran

2016

J Anaesthesiol Clin Pharmacol

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Background and Aims:Role of epidural dexmedetomidine in providing analgesia is well documented, but its effect on oxygenation and shunt fraction is not well established. We studied the hypothesis that epidural dexmedetomidine may improve oxygenation and shunt fraction during one-lung ventilation (OLV).Material and Methods:After taking Institutional Ethics Committee approval, sixty patients undergoing thoracotomy and OLV were randomized to receive epidural ropivacaine with saline (RS group) or epidural ropivacaine with dexmedetomidine (RD group). Group RS received 7 ml of ropivacaine 0.5% with 1.5 ml normal saline (NS) bolus while RD group received 7 ml of 0.5% ropivacaine with 1 mcg/kg dexmedetomidine reconstituted in 1.5 ml NS. This was followed by infusion of 5 ml/h of 0.5% ropivacaine in RS group and 5 ml/h of 0.5% ropivacaine containing 0.2 mcg/kg of dexmedetomidine in RD group. Arterial and central venous blood gas parameters were obtained 15 minutes after intubation during two lung ventilation (TLV15), 15 and 45 min after OLV (OLV15, OLV45) and 15 minutes after reinstitution of two lung ventilation (ReTLV).Results:RD group had better oxygenation (254.2 ± 72.3 mmHg, 240.60 ± 59.26 mmHg) as compared to RS group (215.2 ± 64.3 mmHg, 190.7 ± 61.48 mmHg) at OLV15 (P – 0.04) and OLV45 (P – 0.004) respectively. Shunt fraction in RD group was (30.31 ± 7.89%, 33.76 ± 8.89%) and (35.14 ± 7.58%, 39.57 ± 13.03%) in RS group at OLV15 and OLV45, respectively. The increase in the shunt fraction from TLV15 was significantly greater in RS group than RD group both at OLV15 (P – 0.03) and OLV45 (P – 0.03). The sevoflurane and fentanyl requirement was lower in RD group.Conclusion:Epidural dexmedetomidine improves oxygenation and reduces shunt fraction during OLV, in patients undergoing thoracotomy. It also reduces intraoperative anesthetic and analgesic requirement.

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“…Garutti et al 53 showed that when TEA was added to general anesthesia during unilateral ventilation for thoracic surgery, PaO 2 and shunt fraction were slightly worse (by ~60 mmHg and 5%, respectively) compared to general anesthesia alone. They hypothesized that this was due to the inhibition of HPV resulting from sympathetic blockade of the noradrenergic innervation to the pulmonary vasculature.…”

Section: Case I: Lung Resection In a Patient With Copdmentioning

confidence: 99%

Pulmonary Pathophysiology and Lung Mechanics in Anesthesiology

Melo

Musch

Kaczka

2012

Anesthesiology Clinics

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The induction and maintenance of anesthesia, surgical requirements, and patients’ unique pathophysiology all combine to create a setting in which our accumulated knowledge of respiratory physiology and lung mechanics take on immediate and central importance in patient management. In this review we will take a case-based approach to illustrate how the complex interactions between anesthesia, surgery, and patient disease impact patient care with respect to pulmonary pathophysiology and clinical decision-making. We will examine two disparate scenarios: a patient with chronic obstructive pulmonary disease undergoing a lung resection, and a patient with coronary artery disease undergoing cardiopulmonary bypass. In each example we will illustrate how important concepts in pulmonary physiology and respiratory mechanics impact clinical management decisions.

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Arterial Oxygenation During One-Lung Ventilation

Cited by 29 publications

References 14 publications

The effects of thoracic epidural analgesia on oxygenation and pulmonary shunt fraction during one-lung ventilation: an meta-analysis

The effects of thoracic epidural analgesia on oxygenation and pulmonary shunt fraction during one-lung ventilation: an meta-analysis

The effect of epidural dexmedetomidine on oxygenation and shunt fraction in patients undergoing thoracotomy and one lung ventilation: A randomized controlled study

Pulmonary Pathophysiology and Lung Mechanics in Anesthesiology

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