Document Detail


The effect of thoracic epidural anesthesia on pulmonary shunt fraction and arterial oxygenation during one-lung ventilation.
MedLine Citation:
PMID:  19945297     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To compare the effect of thoracic epidural local anesthetic, epidural opioid, and intravenous opioid on pulmonary shunt fraction, arterial oxygenation, and hemodynamic changes during one-lung ventilation (OLV) in patients undergoing thoracic surgery. DESIGN: A prospective, randomized, double-blind study. SETTING: A university hospital. PARTICIPANTS: Thirty-nine patients undergoing OLV for pulmonary resection. INTERVENTIONS: Patients were randomized into 1 of 3 groups: epidural bupivacaine (TEA-B group, n = 13), epidural sufentanil (TEA-S group, n = 13), or intravenous remifentanil (IV-R group, n = 13) during general anesthesia with propofol. A double-lumen tube was inserted, and mechanical ventilation with 100% oxygen was used in the lateral decubitus position. MEASUREMENTS AND MAIN RESULTS: Hemodynamic variables and arterial and mixed venous blood gas analysis from the radial and pulmonary artery catheter were measured and shunt fraction was calculated during two-lung ventilation (TLV), 15, 30, and 60 minutes after the initiation of OLV, and 15 minutes after the reinstitution of TLV. Although mean arterial pressures 15 and 30 minutes after OLV in the IV-R group were significantly higher than the value in TEA-S group, cardiac output and pulmonary vascular resistance were maintained. Decreases in PaO(2), SaO(2), PvO(2), and SvO(2) and an increase in the shunt fraction after OLV were not different among groups and returned to baseline value after the resumption of TLV. CONCLUSIONS: Thoracic epidural bupivacaine, epidural sufentanil, and intravenous remifentanil-combined general intravenous anesthesia have comparable effects on shunt fraction and arterial oxygenation during OLV in patients undergoing thoracic surgery.
Authors:
Sung Mee Jung; Choon Kyu Cho; Young Jin Kim; Hyun Min Cho; Chul-Woung Kim; Hee Uk Kwon; Eung Kyun Kim; Jeong Min Park
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2009-11-27
Journal Detail:
Title:  Journal of cardiothoracic and vascular anesthesia     Volume:  24     ISSN:  1532-8422     ISO Abbreviation:  J. Cardiothorac. Vasc. Anesth.     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-05-31     Completed Date:  2010-08-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9110208     Medline TA:  J Cardiothorac Vasc Anesth     Country:  United States    
Other Details:
Languages:  eng     Pagination:  456-62     Citation Subset:  IM    
Copyright Information:
Copyright 2010 Elsevier Inc. All rights reserved.
Affiliation:
Department of Anesthesiology, Konyang University Hospital, Daejeon, Korea. applejsm@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Anesthesia, Epidural*
Anesthesia, General
Anesthesia, Intravenous
Anesthetics, Local
Blood Gas Analysis
Bupivacaine
Double-Blind Method
Female
Heart Rate / drug effects
Hemodynamics / physiology
Humans
Lung / metabolism*,  surgery
Male
Middle Aged
Oxygen / blood*
Premedication
Respiration, Artificial*
Respiratory Function Tests
Thoracic Surgical Procedures
Chemical
Reg. No./Substance:
0/Anesthetics, Local; 2180-92-9/Bupivacaine; 7782-44-7/Oxygen

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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