Effects of propofol vs sevoflurane on arterial oxygenation during one-lung ventilation

Background: The inhibitory effect of anaesthetic agents on hypoxic pulmonaryvasoconstriction may depend upon their dose, especially whenusing a volatile agent. The aim of this randomized open studywas to compare the effects of sevoflurane and propofol, as primaryanaesthetic agents, on oxygenation during one-lung ventilation(OLV), with their administration being adjusted to maintainbispectral index (BIS) values between 40 and 60. Methods: Eighty patients scheduled for a lobectomy, receiving an epiduralmixture of ropivacaine and sufentanil, were randomly assignedto Group S (maintenance with sevoflurane) or Group P (maintenancewith propofol). After placement of a double-lumen tube, thelungs were ventilated at an inspiratory fraction of oxygen of1.0, a tidal volume of 6 ml kg^–1, and 12 bpm. Arterialblood gas samples were taken as follows: during two-lung ventilationbefore OLV, and during the first 40 min of OLV. Results: Fifteen patients were excluded (incorrect placement of the tubeor BIS outside the desired range). The two groups were comparablein terms of demographic variables, haemodynamic, and BIS levelsduring the operation. Four patients in each group had a Sp_O2<90%.Mean of the lowest Pa_O2 was 16.3 (7.5) kPa in Group S and 17.7(9.3) kPa in Group P (ns). Conclusions: Sevoflurane and propofol had similar effect on Pa_O2 during OLVwhen their administration is titrated to maintain BIS between40 and 60.     

Effects of propofol and desflurane anaesthesia on the alveolar inflammatory response to one-lung ventilation

Background: One-lung ventilation (OLV) induces a pro-inflammatory responseincluding cytokine release and leucocyte recruitment in theventilated lung. Whether volatile or i.v. anaesthetics differentiallymodulate the alveolar inflammatory response to OLV is unclear. Methods: Thirty patients, ASA II or III, undergoing open thoracic surgerywere randomized to receive either propofol 4 mg kg^–1 h^–1(n = 15) or 1 MAC desflurane in air (n = 15) during thoracicsurgery. Analgesia was provided by i.v. infusion of remifentanil(0.25 µg kg^–1 min^–1) in both groups. The patientswere mechanically ventilated according to a standard protocolduring two-lung ventilation and OLV. Fibre optic bronchoalveolarlavage (BAL) of the ventilated lung was performed before andafter OLV and 2 h postoperatively. Alveolar cells, protein,tumour necrosis factor (TNF), interleukin (IL)-8, soluble intercellularadhesion molecule-1 (sICAM), IL10, and polymorphonuclear (PMN)elastase were determined in the BAL fluid. Data were analysedby parametric or non-parametric tests, as indicated. Results: In both groups, an increase in pro-inflammatory markers wasfound after OLV and 2 h postoperatively; however, the fractionof alveolar granulocytes (median 63.7 vs 31.1%, P < 0.05)was significantly higher in the propofol group compared withthe desflurane group. The time courses of alveolar elastase,IL-8, and IL-10 differed between groups, and alveolar TNF (7.4vs 3.1 pg ml^–1, P < 0.05) and sICAM-1 (52.3 vs 26.3ng ml^–1, P < 0.05) were significantly higher in thepropofol group. Conclusions: These data indicate that pro-inflammatory reactions during OLVwere influenced by the type of general anaesthesia. Differentpatterns of alveolar cytokines may be a result of increasedgranulocyte recruitment during propofol anaesthesia.     

比较地氟醚、丙泊酚在单肺通气时对肺内分流的影响

目的　探讨地氟醚与丙泊酚在单肺通气期间对肺内分流、动脉氧分压的影响。方法　30例胸科手术病人 ,随机分为地氟醚组 (D组 ,1MAC)和丙泊酚组 (P组 ,6mg·kg 1·h 1)行循环紧闭麻醉。在手术前分别于平卧位双肺通气 30min、平卧位单肺通气 30min、侧卧位单肺通气 30min ,采集动脉血和混合静脉血行血气分析 ,计算肺内分流率。结果　在单肺通气后 ,D组和P组肺内分流增加明显 (P <0 0 1)。但平卧位分别增加 14 1%和 13 3% (P >0 0 5 ) ,侧卧位分别增加 13 2 %和12 7% (P >0 0 5 ) ,两组间无显著性差异。D组和P组动脉氧分压明显下降 (P <0 0 1) ,且平卧位比侧卧位下降更为明显。结论　 1MAC地氟醚在循环紧闭麻醉单肺通气期间对肺内分流和动脉氧合无明显的抑制。     

A comparison of the effects of desflurane and isoflurane on arterial oxygenation during one-lung ventilation

In a randomised prospective cross-over study, we compared the effects of desflurane and isoflurane on arterial oxygenation, heart rate and mean arterial pressure during one-lung anaesthesia. Thirty patients scheduled for oesophagogastrectomy were randomly assigned to one of two groups. One group of 15 patients received desflurane to an end-tidal concentration of 6% in oxygen from induction until the end of 30 min of open chest one-lung ventilation in the lateral position. This was followed by isoflurane to an end-tidal concentration of 1.1% in oxygen for the next 30 min of one-lung ventilation. The other group of 15 patients received the two anaesthetic agents in the reverse order. We found no significant difference in arterial oxygenation, heart rate or mean arterial pressure between the two inhalational agents. In the subgroup of 10 patients with pulmonary artery catheters, we found no significant differences in mixed venous saturation, derived shunt or cardiac output. We conclude that during one-lung ventilation, the choice between desflurane and isoflurane does not significantly influence arterial oxygenation.     

Effects of PEEP on oxygenation and respiratory mechanics during one-lung ventilation

Background. One-lung ventilation-related hypoxaemia (OLV-RH)can occur in patients with healthy lungs. In this case, PEEPfrequently improves oxygenation. The aim of this study was todetermine, in a healthy lung model of OLV, whether the increasein PEEP improved oxygenation and whether the mechanisms involvedinclude both inspiratory lung recruitment and an end-expiratorylung volume increase. Since inhaled nitric oxide (iNO) may havea synergistic effect on oxygenation in the case of PEEP-inducedrecruitment, their association was also tested. Methods. Twenty pigs were studied during open-chest, left OLV.Arterial blood gases and haemodynamic variables were measuredat different levels of PEEP (0, 5, 10 and 15 cm H₂O) appliedin random order with or without iNO 4 p.p.m. Pressure–volumecurves were measured at each level of PEEP. Results. PEEP₅ and PEEP₁₀ improved / ratio (P<0.005) and shunt (P<0.005) regardlessof the presence of iNO. PEEP₁₅ improved oxygenation and shuntonly when it was associated with iNO (P<0.001). Whereas PEEP₅,PEEP₁₀ and PEEP₁₅ were associated with a significant increasein end-expiratory volume (P<0.001), only PEEP₅ and PEEP₁₀were associated with continuous lung volume recruitment (P<0.01).Moreover, PEEP₁₅ induced a significant decrease in linear compliance(P<0.001). Conclusions. In a healthy porcine lung model of OLV-RH, moderatePEEP can improve oxygenation. This effect implies both expiratoryand inspiratory pulmonary recruitment. Co-administration of4 p.p.m. iNO was ineffective.     

比较地氟醚与异丙酚在电视胸腔镜手术中对病人氧合的影响

目的比较地氟醚和异丙酚在电视胸腔镜手术单肺通气中对病人的氧合影响.方法择期行电视胸腔镜手术病人20例,ASAⅡ～Ⅲ级,随机分为地氟醚组(D组)和异丙酚组(P组),每组10例.麻醉诱导P组或D组分别用芬太尼4μg@kg-1、维库溴铵0.1mg@kg-1、琥珀胆碱100mg,异丙酚2mg@kg-1(P组)或2.5%硫喷妥钠5mg@kg-1(D组),以2～8mg@kg-1@h-1异丙酚(P组)或2%～4%地氟醚(D组)、芬太尼、维库溴铵维持麻醉.静脉诱导后经口腔插入Carlen双腔支气管导管.监测术中MAP及HR的变化,并分别于术前、TLV30min、OLV30min、OLV60min取桡动脉血做血气分析.结果两组病人均于单肺通气后PaO2虽明显下降(P＜0.05),但PaO2＞60mmHg,组间无显著性差异.D组术中MAP明显低于术前,而P组无显著性变化.结论地氟醚与异丙酚均可安全地应用于单肺通气手术的麻醉.     

不同浓度布比卡因胸段硬膜外阻滞对单肺通气期间动脉氧合的影响

目的观察不同浓度布比卡因胸段硬膜外阻滞对单肺通气(OLV)期间动脉氧合的影响。方法择期行经左胸食管癌根治术患者120例,年龄50~65岁,随机数字表法均分为四组:A、B、C组采用静脉全麻复合硬膜外阻滞,硬膜外分别给予0.5%、0.25%、0.125%布比卡因,D组为单纯静脉全麻,每组30例。A、B、C三组患者诱导前硬膜外注入5ml相应浓度布比卡因,术中以3~5ml/h持续硬膜外泵入。分别于OLV前(T0)、OLV 15min(T1)、OLV 30min(T2)抽取桡动脉血和混合静脉血行血气分析。结果 T1、T2时A组Qs/Qt明显高于其他三组(P0.05),PaO2明显低于其他三组(P0.05)。T0~T2时A、B组SBP、DBP均明显低于D组(P0.05)。与D组比较,A、B、C组术中阿片类药物和丙泊酚的用量均明显减少(P0.05)。结论静脉全麻复合0.125%和0.25%布比卡因胸段硬膜外阻滞在OLV期间不会增加肺内分流和降低动脉氧合。     

Effects of sevoflurane and propofol on pulmonary shunt fraction during one-lung ventilation for thoracic surgery

Forty patients requiring one-lung ventilation (OLV) for thoracicsurgery were randomly assigned to receive propofol (4-6 mg kg^–1h^–1) or sevoflurane (1 MAC) for maintenance of anaesthesia.Three sets of measurements were taken: (i) after 30 min of two-lungventilation (TLV), (ii) after 30 min of one-lung ventilation(OLV-1) in the supine position and (iii) during OLV in the lateralposition (OLV-2) with the chest open and before surgical manipulationof the lung. There were no differences between groups in patientcharacteristics or preoperative condition. Increases in shuntfraction during OLV-1 were 17.4% and 17.2% (P=0.94), those duringOLV-2 were 18.3% and 16.5% (P=0.59) for the propofol and sevofluranegroup, respectively. Cardiac index and other haemodynamic andrespiratory variables were similar for the two groups. We concludethat inhibition of hypoxic pulmonary vasoconstriction by sevofluranemay only account for small increases in shunt fraction and thatmuch of the overall shunt fraction during OLV has other causes. Br J Anaesth 2001; 86: 38–43     

地氟醚麻醉深度对单侧肺通气时肺内分流的影响

目的观测地氟醚麻醉深度对单侧肺通气(OLV)时低氧性肺血管收缩(HPV)的影响。方法择期行左侧开胸的成年手术患者36例,ASAⅠ~Ⅱ级,随机分为丙泊酚组(P组)、0·5MAC地氟醚组(D1组)和1MAC地氟醚组(D2组),每组12例。分别用咪唑安定0·2mg/kg(D1组和D2组)、丙泊酚4μg/ml靶控输注(P组),三组均用芬太尼4μg/kg和罗库溴铵0·9mg/kg行静脉诱导,经口插入Mallinckrodt右双腔支气管导管。以3%地氟醚(D1组)、6%地氟醚(D2组)、丙泊酚[P组,保持脑电双频指数(BIS)在40~49]、芬太尼、罗库溴铵维持麻醉。于双侧肺通气15min(TLV-15)、右OLV15min(OLV-15)、右OLV30min(OLV-30)时取足背动脉血和右心房静脉血做血气分析,计算肺内分流率(Qs/Qt)。结果D2组OLV后Qs/Qt均值超过30%,OLV-15时Qs/Qt增幅比D1组大70·6%(P<0·05)。三组OLV后动脉血氧分压(PaO2)降幅均超过40%(P<0·01)。结论1MAC地氟醚对OLV时HPV有明显抑制作用,0·5MAC地氟醚影响轻微。     

Effects of sevoflurane compared with those of isoflurane on arterial oxygenation and hemodynamics during one-lung ventilation

Purpose. This study was designed to compare the effects of sevoflurane and isoflurane on Pao₂ and hemodynamic variables during one-lung ventilation (OLV) in surgical patients. Methods. Twelve patients undergoing an esophageal procedure with thoracotomy for which a long period of OLV was required were studied using a randomized crossover design. Group 1 received 1.2% isoflurane from the induction of anesthesia until 30 min after starting OLV, and then received 1.7% sevoflurane during the remaining period. In group 2, the order of the anesthetics was reversed. All experimental procedures were performed in the left lateral decubitus position with the chest opened. Arterial and mixed venous blood gases and cardiac outputs were analyzed immediately before OLV, during OLV, and after resumption of two-lung ventilation (TLV). Results. OLV produced lower Pao₂ and higher venous admixture (Q _s/Q _t) values than TLV. However, there was no significant difference between sevoflurane and isoflurane in Pao₂ or Q _s/Q _t during OLV. Other hemodynamic variables except for Pvˉo₂ showed no significant differences between the anesthetics. Conclusion. The effects of sevoflurane on Pao₂ and the hemodynamic variables were similar to those of isoflurane during TLV and OLV in the lateral decubitus position. Received for publication on January 29, 1999; accepted on August 6, 1999     

瑞芬太尼复合异丙酚靶控输注对单肺通气时血液氧合及肺内分流的影响

目的 探讨瑞芬太尼复合异丙酚靶控输注在食道手术单肺通气下对血流动力学、血液氧合及肺内分流率的影响。方法 45例ASAI～Ⅱ级术中需要单肺通气的择期食道癌手术患者随机分成3组，每组15例：瑞芬太尼和异丙酚靶控组（RP组），芬太尼复合异丙酚靶控组（FP组），异氟醚组（IS组）。通过靶控分别输入瑞芬太尼和异丙酚、芬太尼和异丙酚及吸入异氟烷维持麻醉。连续监测心电图（ECG）、指脉搏氧饱和度（SPO2）、平均动脉压（MAP）、中心静脉压（CVP）、呼气末CO2分压（PETCO2）和HR。分别于清醒仰卧位吸空气时（TO），麻醉双肺通气15min（T1），单肺通气15min（T2）、30min（T3）、60min（T4）、120min（T5）及再次双肺通气30min（T6）等7个时间点分别经桡动脉、颈内静脉采集动脉血和混合静脉血2ml进行血气测定，计算肺内分流率（Qs／Qt）。结果IS组MAP在T01下降大于其余两组（P＜0．05）、在T02上升大于其余两组（P＜0．05），IS组HR在T02增高大于其余两组（P＜0．05）；3组患者PaO2在吸入纯氧后均于T1时达到最高在T3时降至最小，后又逐渐增高；与T0相比，PaO2在麻醉后各时点均显著增加。PO2在麻醉后各时点均有不同程度的增加，但IS组增加更明显（P＜0．05）。Qs／Qt在T3左右达到最高后逐渐降低；IS组在T2～6时点增加更明显。RP组拔管时间明显缩短（P＜0．05）。结论 3种麻醉方法术中均能满足手术要求。瑞芬太尼或芬太尼复合异丙酚靶控输注能维持更稳定的血流动力学，改善动脉血氧和降低肺内分流。瑞芬太尼复合异丙酚靶控输注术毕苏醒迅速且苏醒质量高。     

Different benefit of bispectal index (BIS) in desflurane and propofol anesthesia

BACKGROUND: Bispectal index (BIS) monitoring may reduce drug usage and hasten recovery in propofol and inhalation anesthesia. The faster emergence profile of desflurane may reduce the effect of BIS monitoring on recovery from desflurane compared with propofol. This study compared hypnotic drug usage, recovery, patient satisfaction and incidence of inadequate sedation in BIS monitored and nonmonitored women anesthetized with desflurane or propofol. METHODS: One hundred and sixty patients scheduled for elective gynecological surgery were randomly assigned to desflurane or propofol anesthesia with and without BIS monitoring. Fentanyl, vecuronium and remifentanil were administered according to clinical criteria. The BIS monitor was used in all patients, but the monitor screen was covered in the controls. A BIS level between 45 and 55 was targeted in the BIS monitored patients whereas depth of anesthesia was assessed by clinical criteria in the controls. RESULTS: The mean (SD) desflurane MAC-hours administered with and without BIS were 0.70 (0.15) and 0.76 (0.12), respectively, resulting in extubation times of 6.5 (4.1) and 8.3 (6.1) min. (NS). Bispectal index monitoring was associated with improved patient satisfaction, reduced postoperative nausea and antiemetic drug requirement, and fewer episodes with sustained BIS levels > 60. The mean (SD) propofol infusion rates were 6.0 (1.4) and 6.6 (0.9) mg kg(-1)h(-1) with and without the BIS monitor (P = 0.023), resulting in mean (SD) extubation times of 6.8 (4.6) and 10.5 min (5.9), respectively (P < 0.05). CONCLUSION: Bispectal index monitoring reduced propofol usage and hastened recovery after propofol anesthesia, whereas in desflurane anesthesia it was associated with improved patient satisfaction, probably because of decreased postoperative nausea and fewer episodes of inadequate hypnosis.     

单肺通气期潮气量对肺内分流及动脉氧合的影响

目的 研究单肺通气(OLV)时不同潮气量(V_T)对肺内分流及动脉氧合的影响.方法 60例右肺部分切除术患者随机均分为A、B、C三组.全麻后双肺通气(TLV)时V_T均为10 ml/kg,RR均为12次/分,吸呼比(I:E)均为1:2.OLV期间,A组V_T6 ml/kg,RR 20次/分;B组V_T 8 ml/kg,RR 15次/分;C组V_T 10 ml/kg,RR 12次/分;分别于OLV前(T_1)及OLV后10 min(T_2)、20min(T_3)、30 min(T_4)行血气分析,计算肺内分流(Q_S/Q_T),同时监测气道压力并计算肺顺应性(Cdyn).结果 与T_1时比较,T_2～T_4时三组均有PaO_2下降,Q_S/Q_T气道峰压(P_(max))增高,Cdyn下降(P<0.05).与A组比较,B组PaO_2升高(P<0.05).结论 OLV期间采用V_T 8 ml/kg,RR 15次/分能够维持相对较好的PaO_2和CAyn,较小的Q_S/Q_T.     

Effects of isoflurane on oxygenation during one-lung ventilation in pulmonary emphysema patients

Background: Hypoxic pulmonary vasoconstriction has an important role in human one-lung ventilation (OLV) in the lateral decubitus position under general anesthesia. During OLV, inhalational anesthesia may inhibit hypoxic pulmonary vasoconstriction and the decrease in arterial oxygenation. We studied the effect of isoflurane administration on arterial oxygen tension in chronic obstructive pulmonary disease patients.
Methods: Ten patients who had thoracoscopic laser ablation of bullous emphysema were studied. Patients received 2% isoflurane in oxygen from induction until the first 20 min of OLV in the lateral decubitus position, then were switched to 1% isoflurane lasting 20 min and next were switched to 0.5% isoflurane lasting 20 min. After each 20-min inhalation, pulmonary and hemodynamic parameters were measured. The given concentrations for isoflurane were merely vapor meter concentrations.
Results: PaO₂/FIO₂, Qs/Qt respiratory rate peak inspiratory pressure and PaCO₂ showed no significant changes at each point of isoflurane. Expiratory tidal volume significantly decreased (P<0.05) with 0.5% isoflurane compared to that with 2% isoflurane. Cardiac output, mean arterial pressure, mean pulmonary arterial pressure, systemic vascular resistance and pulmonary vascular resistance showed no significant changes at each point of isoflurane.
Conclusions: In patients with pulmonary emphysema, arterial oxygenation is not affected by low isoflurane concentration during OLV in the lateral decubitus position.     

血液稀释对单肺通气麻醉期间脑氧合的影响

目的观察不同程度血液稀释对单肺通气全麻手术中脑氧合的影响。方法30例单纯肺叶切除术行单肺通气的患者,随机均分为血液稀释组和对照组。血液稀释组分别在单肺通气后血液稀释前（T1）、Hct达（30±1）％（T2）和Hct达（26±1）％（T3）三个不同时点,对照组则在相对应的时点同步从动脉和颈内静脉取血作血气分析和乳酸测定,并记算颈内静脉血氧饱和度（SjvO2）、动脉颈内静脉血氧含量差（DA-jvO2）、脑氧摄取率（CERO2）和动脉-颈内静脉血乳酸含量差（DA-jvL）。结果血液稀释组在T2时SjvO2较T1时升高,DA-jvO2和CERO2较T1时降低（P〈0．05）;T3时与T1时比较虽有变化,但差异无统计学意义。与对照组比,m液稀释组Tz时SjvO2升高,DA-jvO2和CERO2降低,差异有统计学意义（P〈0．01）;T3时SjvO2、DA-jvO2和CER02差异无统计学意义。两组患者DA-jvL组内组间差异无统计学意义。结论单肺通气全身麻醉期间血液稀释到Hct达（30±1）％时脑氧合状况较佳,Hct达（26±1）％时不会影响脑氧合状况。     

全麻复合硬膜外阻滞对单肺通气期间肺内分流的影响

目的：探讨全麻复合高位硬膜外阻滞对单肺通气期间肺内分流（Qs/Qt )的影响。方法：择期开胸手术病人30例随机分为两组：全麻复合硬膜外组（A组）和全麻组（B组）。两组病人分别于麻醉前、双肺通气20分钟、单肺通气15、30分钟时采动脉血及混合静脉血行血气分析，并计算出Qs/Qt等。结果：单肺通气时，两组病人Qs/Qt较双肺通气时显著增加（P＜0．01），PaO2显著降低（P＜0．05）。单肺通气15、30分钟时，A组病人Qs/Qt显著大于B组（P＜0．01）；PaO2显著低于B组（P＜0．05）。麻醉期间A组病人心率亦显著慢于B组（P＜0．05）。结论：单肺通气期间，全麻复合硬膜0．05）。麻醉期间A组病人心率亦显著慢于B组（P＜0．05）。结论：单肺通气时间，全麻复合硬膜外阻滞可引起Qs/Qt增加，PaO2降低，可能与硬膜外阻滞削弱低氧性肺血管收缩机制（HPV）有关。     

肺泡征募对单肺通气时氧合和肺内分流的影响

目的探讨肺泡征募(ARS)通气方式对单肺通气(OLV)时氧合和肺内分流的影响。方法择期行食管癌根治术患者24例随机分为观察组和对照组。全麻诱导后插入右双腔支气管导管,开胸后行OLV。观察组ARS于开胸后15min进行。记录动脉血压、HR和SpO2,并在侧卧后双肺通气(TLV)15min、OLV15min、OLV40min行动脉血气分析,以简化肺内分流公式计算肺内分流率(Qs/Qt)值。结果TLV15min和OLV15min时,观察组和对照组的SpO2、SaO2、PaO2、Qs/Qt和PaCO2差异无显著意义(P>0.05)。OLV40minARS观察组较对照组PaO2显著增加(P<0.05),Qs/Qt明显降低(P<0.05)。结论ARS通气方式在麻醉状态下OLV时可改善肺内氧合,降低肺内分流。