Abstract
Patients with chronic obstructive pulmonary disease (COPD) are usually anesthetized with an inhalation agent. After Institutional Review Board approval, informed consent was obtained from 60 patients with moderate to severe COPD according to a preoperative severity scoring system, which took into account history and objective findings. By using objective criteria, such patients were randomly assigned to receive propofol (group I) or isoflurane (group II) as primary maintenance agents. Preoperative and postoperative arterial blood gases, peak expiratory flow rates (PEFR), and chest X-rays were compared. Total dynamic compliance (C DYN) and V 1 (1% volume exhaled in first second) were measured using Pitot tube sidestream spirometry. A 1,000-mL super-syringe was used to measure total static compliance (C ST). Measurements were recorded postintubation, midanesthesia, and pre-extubation. All patients received fentanyl, lidocaine, and propofol, 1.5 to 2.0 mg/kg, for induction. Succinylcholine, 1-1.5 mg/kg, was administered to facilitate intubation. Maintenance was with N 2O-O 2, vecuronium, and either propofol ( n = 30) or isoflurane ( n = 30). Both group showed decreases in postoperative PaO 2, SaO 2, and PEFR ( p < 0.05), but there were no differences between groups ( p > 0.05). There were no significant chest X-ray differences. There were no differences between groups with respect to intraoperative pulmonary mechanics ( p > 0.05). The only difference between groups was an increase in postoperative PaCO 2 in group I and a decrease in group II ( p < 0.05). Use of Pitot tube sidestream spirometry is a practical and noninvasive technique for monitoring pulmonary mechanics during anesthesia. It was concluded that propofol and isoflurane as primary maintenance anesthetic agents are objectively and clinically equivalent in patients with COPD.
Published Version
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