Abstract
Objective:To investigate the effect of epidural anesthesia combined with inhalation or intravenous anesthesia on intrapulmonary shunt and oxygenation in patients undergoing long term single lung ventilation.Methods:Eighty patients, aged 35-75, American Society of Anesthesiology (ASA) classification of I-III, undergoing thoracic surgery with one lung ventilation more than three hour, were randomly divided into propofol group (group Pro), propofol combined with epidural anesthesia group (group Pro+Epi), isoflurane group (group Iso) and isoflurane combined with epidural anesthesia group (group Iso+ Epi), 20 patients in each group. Arterial blood and mixed venous blood were taken for blood gas analysis, and hemodynamic data were recorded at following time points: before induction in supine position (T1), 30min after bilateral lung ventilation (T2), 15min after one lung ventilation (T3), 30min after one lung ventilation (T4), 60min after one lung ventilation (T5), 180min after one lung ventilation (T6), intrapulmonary shunt (Qs/Qt) was calculated according to the correlation formula.Results:Qs/Qt values at T2-6 in four groups were significantly higher than that of T1, and Qs/Qt values at T3-6 was significantly higher than that of T2 (P< 0.05); PaO2 at T2-6 were significantly higher than that of T1, with PaO2 at T3-6 were significantly lower than T2 (P< 0.05). Between groups, Qs/Qt values in group Iso were significantly higher than that of group Pro, Pro+Epi and Iso+Epi at T3-5 (P< 0.05). There was no significant difference in PaO2 between groups (P> 0.05). CI at T3-6 in group Iso and Iso+Epi were significantly higher than that of T1 (P<0.05), and were significantly higher than that of propofol group (P<0.05). MAP at T3-6 in group Pro+Epi and Iso+Epi were significantly lower than that at T1 (P <0.05). Heart rate at T4-6 in group Iso were significantly higher than T1, and higher than group Pro and group Iso+Epi (P <0.05).Conclusion:One lung ventilation may predispose to increase of intrapulmonary shunt and decrease in arterial partial pressure of oxygen; isoflurane inhalation anesthesia is more likely to cause intrapulmonary shunt, but no changes in arterial partial pressure of oxygen.
Highlights
Thoracic surgery often requires one lung ventilation, which may lead to increase in intrapulmonary shunt, decrease of PaO2.1,2 Hypoxic pulmonary vasoconstriction (HPV) is a protective and self regulating mechanism of the pulmonary circulation system in hypoxia, which can greatlyPak J Med Sci July - August 2018 Vol 34 No 4 www.pjms.com.pk 799 reduce the proportion of the pulmonary blood flow to the cardiac output, and improve the pulmonary blood flow under ventilation, and stabilize the PaO2.3,4 HPV can be influenced by various factors such as different anesthesia and drugs,[5] there is limited robust information about how HPV regulate itself independently and pathological changes of one lung ventilation up to three hour, especially under different anesthesia
We investigated the effects of intravenous and inhalation anesthesia combined with epidural anesthesia on intrapulmonary shunt and arterial oxygenation in patients undergoing long term one lung ventilation
We found that intrapulmonary shunt increased from initiation of one lung ventilation and reached a peak at 30min after initiation of one lung ventilation, gradually decreased for the influence of HPV
Summary
Thoracic surgery often requires one lung ventilation, which may lead to increase in intrapulmonary shunt, decrease of PaO2.1,2 Hypoxic pulmonary vasoconstriction (HPV) is a protective and self regulating mechanism of the pulmonary circulation system in hypoxia, which can greatly. Pak J Med Sci July - August 2018 Vol 34 No 4 www.pjms.com.pk 799 reduce the proportion of the pulmonary blood flow to the cardiac output, and improve the pulmonary blood flow under ventilation, and stabilize the PaO2.3,4 HPV can be influenced by various factors such as different anesthesia and drugs,[5] there is limited robust information about how HPV regulate itself independently and pathological changes of one lung ventilation up to three hour, especially under different anesthesia. We investigated the effects of intravenous and inhalation anesthesia combined with epidural anesthesia on intrapulmonary shunt and arterial oxygenation in patients undergoing long term one lung ventilation
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