Chonnam Med J.  2002 Sep;38(3):218-227.

The Effects of Anesthetic Techniques on Arterial Oxygenation and Pulmonary Shunt during one Lung Ventilation

• Kwak SH
• Choi JI
• Ha JS
• Park HC

Abstract

During one-lung ventilation (OLV) for thoracic surgery, hypoxic pulmonary vasoconstriction(HPV) may reduce venous admixture and ameliorate the decrease in arterial oxygenation by diverting blood from the non-ventilated to the ventilated lung. Volatile anesthethics have been widely used in thoracic surgery despite the numerous experimental data showing their inhibiting effect on the HPV. And recently, total intravenous anesthesia (TIVA) with propofol and thoracic epidural anesthesia (TEA) were increasingly used. The object of present study was to compare the effects of isoflurane, propofol, or thoracic epidural anesthesia on oxygenation and shunt during two lung ventilation (TLV) and OLV in human volunteers. Forty-five patients who needed OLV for elective thoracic surgery were randomly assigned to receive one of three groups of isoflurane (1 MAC isoflurane + saline 6 ml TEA + fentanyl + vecuronium, n=15), propofol (2-3 microgram/dl propofol + saline 6 ml TEA + fentanyl + vecuronium, n=15) and TEA (0.5% bupivacaine 6 ml TEA + 0.5-1 microgram/dl propofol + fentanyl + vecuronium, n=15) with 100% oxygen in separate groups. Systemic hemodynamic data were recorded, and blood gas values were obtained 30 min after the start of TLV (TLV-30) and 30, 45, 60 min after the start of OLV (OLV-30, 45, 60) in lateral position. Significant reductions in PaO2 and increases in shunt fraction after the start of OLV, compared with TLV, were observed in all three groups. Reduction of PaO2 and increase of shunt from that of TLV-30 were significantly low at OLV-60 in propofol group than in the other groups. The other data of blood gases (SaO2, SvO2, PaCO2, PvCO2, pH, Hb, CaO2, CvO2) and systemic hemodynamics (mean arterial blood pressure, heart rate, central venous pressure) after the start of OLV were not statistically different compared with TLV in three groups. TIVA with propofol was superior to anesthesia with isoflurane or TEA in terms of the arterial blood oxygenation and pulmonary shunt during OLV for lung surgery.

Keyword

Anesthetic techniques; One lung ventilation; Oxygenation; Shunt

MeSH Terms

Anesthesia
Anesthesia, Epidural
Anesthesia, Intravenous
Arterial Pressure
Bupivacaine
Fentanyl
Gases
Healthy Volunteers
Heart Rate
Hemodynamics
Humans
Hydrogen-Ion Concentration
Isoflurane
Lung
One-Lung Ventilation*
Oxygen*
Propofol
Tea
Thoracic Surgery
Vecuronium Bromide
Ventilation
Bupivacaine
Fentanyl
Gases
Isoflurane
Oxygen
Propofol
Tea
Vecuronium Bromide