The Effect of Thoracic Epidural Anesthesia on Pulmonary Shunt Fraction and Arterial Oxygenation During One-Lung Ventilation

Title
The Effect of Thoracic Epidural Anesthesia on Pulmonary Shunt Fraction and Arterial Oxygenation During One-Lung Ventilation
Author(s)
정성미Cho, Choon Kyu[Cho, Choon Kyu]Kim, Young Jin[Kim, Young Jin]Cho, Hyun Min[Cho, Hyun Min]Kim, Chul-woung[Kim, Chul-woung]Kwon, Hee Uk[Kwon, Hee Uk]Kim, Eung Kyun[Kim, Eung Kyun]Park, Jeong Min[Park, Jeong Min]
Keywords
GENERAL-ANESTHESIA; SYMPATHETIC BLOCK; VASOCONSTRICTION; ANALGESIA; SUFENTANIL; SURGERY; DOGS; REMIFENTANIL; MODULATION; TRIALS
Issue Date
201006
Publisher
W B SAUNDERS CO-ELSEVIER INC
Citation
JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, v.24, no.3, pp.456 - 462
Abstract
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 PaO2, 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. (C) 2010 Elsevier Inc. All rights reserved.
URI
http://hdl.handle.net/YU.REPOSITORY/22327http://dx.doi.org/10.1053/j.jvca.2009.09.011
ISSN
1053-0770
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의과대학 > 마취통증의학교실 > Articles
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