Low- vs high-dose almitrine combined with nitric oxide to prevent hypoxia during open-chest one-lung ventilation

Silva-Costa-Gomes, Teresa; Gallart, Lluís; Vallès, Jordi; Trillo, Lourdes; Minguella, Joan; Puig, Margarita M.

doi:10.1093/bja/aei194

Cited by 37 publications

(20 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Alternatively, agents with vasoconstrictive properties such as almitrine, a direct acting α-adrenergic agonist, may augment HPV and improve oxygenation in certain clinical scenarios. [89]…”

Section: Discussionmentioning

confidence: 99%

Effects of dexmedetomidine on oxygenation during one-lung ventilation for thoracic surgery in adults

et al. 2011

View full text Add to dashboard Cite

STUDY OBJECTIVE:To evaluate the effects of dexmedetomidine on hypoxic pulmonary vasoconstriction (HPV) and oxygenation during one-lung ventilation (OLV) in adults undergoing thoracic surgery.DESIGN:Prospective, randomized, double-blinded trial.SETTING:Tertiary care, University-based hospital.PATIENTS:Nineteen adult patients undergoing thoracic surgery requiring OLV.INTERVENTIONS:During inhalational anesthesia with desflurane, patients were randomized to receive either dexmedetomidine (bolus dose of 0.3 μg/kg followed by an infusion of 0.3 μg/kg/hr) or saline placebo.MEASUREMENTS:Three arterial blood gas samples (ABG) were obtained to evaluate the effects of dexmedetomidine on oxygenation. Secondary outcomes included differences in hemodynamic parameters (heart rate and mean arterial pressure), end-tidal desflurane concentration required to maintain the bispectral index (BIS) at 40-60, supplemental fentanyl to maintain hemodynamic stability, and phenylephrine to keep the mean arterial pressure (MAP) within 10% of baseline values.MAIN RESULTS:Oxygenation during OLV did not change following the administration of dexmedetomidine (PaO2/FiO2 ratio of 188 ± 115 in dexmedetomidine patients versus 135 ± 70 mmHg in placebo patients). There were no differences in hemodynamic variables or depth of anaesthesia between the two groups. With the administration of dexmedetomidine, there was a decrease in the expired concentration of desflurane required to maintain the BIS at 40-60 when compared with the control group (4.5 ± 0.8% versus 5.1 ± 0.8%). In patients receiving dexmedetomidine, fentanyl requirements were decreased when compared to placebo (2.7 μg/kg/patient versus 3.1 μg/kg/patient). However, more patients receiving dexmedetomidine required phenylephrine to maintain hemodynamic stability (6 of 9 patients versus 3 of 10 patients) and the total dose of phenylephrine was greater in patients receiving dexmedetomidine when compared with placebo 10.3 μg/kg/patient versus 1.1 μg/kg/patient).CONCLUSION:Dexmedetomidine does not adversely affect oxygenation during OLV in adults undergoing thoracic surgical procedures. The improvement in oxygenation in the dexmedetomidine patients may be related to a decrease in the requirements for inhalational anaesthetic agents thereby limiting its effects on HPV.

show abstract

Section: Discussionmentioning

confidence: 99%

Effects of dexmedetomidine on oxygenation during one-lung ventilation for thoracic surgery in adults

et al. 2011

View full text Add to dashboard Cite

show abstract

“…Its maximal value for which we cannot reject H 0 is t 1− (ˆ het ). Note that we have to plug in the estimator (X E −X P )/(X R −X P ) for the parameter in (6) to approximate the degrees of freedom. To derive the confidence limits, a quadratic equation is to be solved.…”

Section: Fieller's Confidence Intervalmentioning

confidence: 99%

“…We give two examples. Table I lists the summary statistics for the respiratory variable Pa O 2 (kPa) of a clinical data set of Silva-Costa-Gomes et al [6]. Two treatments, ALM4 + NO and ALM16 + NO, and a placebo were administered 30 min after the onset of one-lung ventilation.…”

Section: Introductionmentioning

confidence: 99%

“…Section 3 deals with the power and sample size determinations to derive a power-optimal design. For all simulations shown in this paper, we used the data set of Silva-Costa-Gomes et al [6] (Table I) as a basis regarding ALM16 + NO as the reference and ALM4 + NO as the experimental drug. We return to the data set by Adler and Kliesch [8] in Section 4, and end, inevitably, with our conclusions in Section 5.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Assessing non‐inferiority of a new treatment in a three‐arm trial in the presence of heteroscedasticity

Hasler

Vonk

Hothorn

2007

Statistics in Medicine

View full text Add to dashboard Cite

In this paper, we describe an adjusted method to facilitate non-inferiority tests in a three-arm design. While the methodology is readily available in the situation of homogeneous group variances, the adjusted method will also maintain the alpha-level in the presence of heteroscedasticity. We propose explicit criteria for an optimal allocation. Depending on the pattern of heterogeneity, remarkably unbalanced designs are power optimal. We will apply the method to a randomized clinical trial and a toxicological experiment.

show abstract

“…Pharmacologic agents such as almitrine (which augments HPV) and inhaled nitric oxide (a selective pulmonary arterial vasodilator) have been demonstrated both separately and in concert to improve oxygenation during one lung ventilation 51 , although these are not typically used in clinical practice.…”

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

View full text Add to dashboard Cite

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.

show abstract

Low- vs high-dose almitrine combined with nitric oxide to prevent hypoxia during open-chest one-lung ventilation

Cited by 37 publications

References 31 publications

Effects of dexmedetomidine on oxygenation during one-lung ventilation for thoracic surgery in adults

Effects of dexmedetomidine on oxygenation during one-lung ventilation for thoracic surgery in adults

Assessing non‐inferiority of a new treatment in a three‐arm trial in the presence of heteroscedasticity

Pulmonary Pathophysiology and Lung Mechanics in Anesthesiology

Contact Info

Product

Resources

About