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Effects of thoracic epidural anaesthesia on pulmonary venous admixture and oxygenation during one‐lung ventilation
Author(s) -
ÖZcan P. E.,
ŞEntürk M.,
Sungur Ulke Z.,
Toker A.,
Dilege Ş.,
Ozden E.,
ÇAmci E.
Publication year - 2007
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.2007.01374.x
Subject(s) - medicine , anesthesia , bispectral index , isoflurane , oxygenation , bolus (digestion) , thoracotomy , propofol , ventilation (architecture) , surgery , mechanical engineering , engineering
Background: In this clinical randomized study, the effects of four anaesthesia techniques during one‐lung ventilation [total intravenous anesthesia (TIVA) with or without thoracic epidural anaesthesia (TEA) (G‐TIVA‐TEA and G‐TIVA), isoflurane anaesthesia with or without TEA (G‐ISO‐TEA and G‐ISO)] on pulmonary venous admixture (Qs/Qt) and oxygenation (OLV) were investigated. Methods: In 100 patients (four groups, 25 patients in each) undergoing thoracotomy, a thoracic epidural catheter was inserted pre‐operatively. In G‐TIVA‐TEA and G‐ISO‐TEA, bupivacaine 0.1% + 0.1 mg/ml morphine was administered intra‐operatively (10 ml of first bolus + 7 ml/h infusion). Propofol infusion or isoflurane concentration was adjusted to keep a bispectral index (BIS) of between 40 and 50 in all groups. FiO 2 was 0.8 during OLV and 0.5 before and after OLV. Partial arterial and central venous oxygen pressures (PaO 2 and PvO 2 ), arterial and venous oxygen saturations and Qs/Qt values were recorded before, during and after OLV. Results: During OLV, PaO 2 was significantly higher and Qs/QT significantly lower in G‐TIVA‐TEA and G‐TIVA compared with G‐ISO‐TEA and G‐ISO (PaO2: 188 ± 36; 201 ± 39; 159 ± 33; 173 ± 42 mmHg, respectively; Qs/Qt: 31.2 ± 7.4; 28.2 ± 7; 36.7 ± 7.1; 33.7 ± 7.7%, respectively). No statistical changes were observed in patients with TEA compared with without TEA in any measurement. Conclusion: During OLV, TEA does not significantly affect the oxygenation and Qs/Qt and can be used safely regardless of whether TIVA or inhalation techniques are used.