Effect of One-Lung Ventilation on Blood Sevoflurane and Desflurane Concentrations

The Consumption of Anesthetic Agents During One-lung Ventilation and a Cost Analysis: a Comparison of Two Techniques

“…[21] An investigation with gas chromatography indicated that both arterial and venous blood concentration of desflurane diminished up to 29% during OLV due to ventilation-perfusion mismatch. [22] In our study, no difference was observed in oxygenation between desflurane and propofol anesthesia during OLV. This was not the main objective of the study, so this result should be interpreted with some limitations.…”

The Effect of Low- Flow Anesthesia on Hemodynamic Parameters and Gas Consumption in Single Lung Ventilation

“…This is important in order to prevent insufficient depth of anesthesia due to shortage of inhalation agents that may be seen in low-flow anesthesia and to allow rapid intervention in the case of deep anesthesia. Also, use of low-flow desflurane, maintaining heat and moisture in the airways; reduces the deterioration of mucociliary activity, preserves the viscosity of secretions and reduces the tendency to atelectasis, especially in patients undergoing thoracic surgery [16] .…”

An Editorial to the Effect of One-Lung Ventilation on Blood Sevoflurane and Desflurane Concentration

“…2 In this issue of the Journal of Cardiothoracic and Vascular Anesthesia, Birick and colleagues studied the pharmacokinetics of desflurane during OLV and hypothesized that the reduction in the arterial-venous concentration of desflurane would be less pronounced than with sevoflurane during OLV because of the decreased solubility of desflurane. 3 Upon the initiation of OLV, the nondependent lung becomes atelectatic, resulting in a reduction of alveolar oxygen and the development of hypoxemia. Mechanisms that can contribute further to this hypoxemia include increased venous admixture through shunts caused by the continued perfusion of the nonventilated lung; inadequate expansion of the ventilated lung; increasing the number of low ventilation-perfusion units and shunts due to atelectasis; absorption atelectasis resulting from high inspired oxygen fraction; patient position; and hemodynamic alterations due to blood loss, the compression of intrathoracic vessels, or the administration of anesthetic agents.…”

“…The authors' hypothesis, based on previous studies with sevoflurane and the decreased solubility of desflurane compared to sevoflurane, was that the arterial venous blood concentration of desflurane during the initiation of OLV would decrease less than sevoflurane. 3 Comparing desflurane to sevoflurane, the alveolar equilibration of sevoflurane or alveolar wash-in to inspired fraction (FA/FI) is 85%, whereas the alveolar equilibration of desflurane is 90% in 30 minutes, the blood gas partition coefficient for sevoflurane is 0.68 compared to 0.42 for desflurane, and the brain-to-gas partition coefficient for sevoflurane is 1.70 versus 1.29 for desflurane. 10 The authors divided their subjects into 4 groups where groups I and III received two-lung ventilation and groups II and IV received OLV.…”

“…Both the authors of this paper and the paper describing sevoflurane pharmacokinetics during OLV caution about the potential risk of intraoperative awareness due to the rapid decline in the blood concentration of inhalational anesthetics despite that none of their patients experienced intraoperative awareness. 2,3 The initial reduction in blood volatile anesthetic concentration is due to the intrapulmonary shunt caused by OLV. This decrease in pulmonary blood flow and FRC will increase the alveolar concentration of the anesthetic gas, possibly explaining the authors' findings of an absence of recall or no change in the BIS value or in the end-tidal concentrations of sevoflurane or desflurane despite a reduced anesthetic blood concentration.…”