Case Scenario: Management of Intraoperative Hypoxemia during One-lung Ventilation

Rozé, Hadrien; Lafargue, Mathieu; Ouattara, Alexandre

doi:10.1097/aln.0b013e3182023ed3

Cited by 51 publications

(34 citation statements)

References 57 publications

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“…HPV is a compensatory mechanism specific to the lung. OLV can make the ventilated lung receive more blood perfusion and non-ventilated lung get reduced perfusion volume, so that PaO 2 can be maintained at a relatively high level (Roze et al, 2011). Lungs contain rich autonomic sensory nerves and numerous scattered neuroendocrine cells, and can secret a large quantity of neurotransmitters, modulators or regulatory peptides with hormonal action.…”

Section: Discussionmentioning

confidence: 99%

Effects of Stellate Ganglion Block on the Peri-operative Vasomotor Cytokine Content and Intrapulmonary Shunt in Patients with Esophagus Cancer

Guo

Jin²,

Yu³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Asian Pac J Cancer Prev, 15 (21), 9505-9509 IntroductionOne-lung ventilation (OLV) has been widely applied to cardiothoracic surgery. In spite of unilateral lung ventilation during OLV, bilateral lungs are perfused, which is bound to result in reduced oxygenation, even hypoxemia (Karzai et al., 2009). Hypoxic pulmonary vasoconstriction (HPV) is a phenomenon that the body regulates respiratory and circulatory functions to maintain the oxygen supply within the normal range under the conditions of decreased oxygen partial pressure. The formation mechanism is relatively complicated. Most studies believe that HPV is the direct effect of hypoxia on pulmonary arterial smooth muscle cells and endothelial cells (Evans et al., 2011;Swenson, 2013), but the effect of intrapulmonary During OLV, ET contents were increased significantly in two groups (P<0.05), and no significant difference was presented (P>0.05). NO content in group S was obviously higher than in group N at T3 (P<0.05), whereas CGRP content in group N was markedly lower than in group S at each time point (P<0.05). Qs/Qt was significantly increased in both groups after OLV, but there was no statistical significant regarding the Qs/Qt at each time point between two groups. Conclusions: Total intravenous anesthesia combined with SGB is conducive to regulation of perioperative vasomotor cytokines in thoracotomy, and has little effect on intrapulmonary shunt at the time of OLV.

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Section: Discussionmentioning

confidence: 99%

Effects of Stellate Ganglion Block on the Peri-operative Vasomotor Cytokine Content and Intrapulmonary Shunt in Patients with Esophagus Cancer

Guo

Jin²,

Yu³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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“…Several mechanisms are described for FIC, including: (1) an inhibition of central sympathetic activity, leading to vagal predominance, causing reflex bronchial contract and inducing a cough (Rozé et al, 2011); (2) inducing pulmonary columnar epithelial cells to release histamine, which enhances cough sensitivity and causes bronchospasm (Kamei et al, 2013;el Baissari et al, 2014); (3) enhancing the excitability of rapidly adapting bronchial receptors or forming a reflex cough (Cinelli et al, 2013); (4) in combination with the μ receptors and κ receptors in the bronchial trees, activating the presynaptic C fiber to release neuropeptides, which cause bronchial smooth muscle contraction and increase vascular permeability, resulting in a choking cough (Jung et al, 2011;Cinelli et al, 2013); (5) the citric acid in citrate fentanyl can trigger bradykinin to be released by the peripheral tissue primary nerve, activating neurokinin-1 and neurokinin-2 receptors and causing neurogenic inflammation and bronchoconstriction and a choking cough (Kamei et al, 2013). All of these mechanisms are well studied; however, there are few methods that can effectively inhibit FIC.…”

Section: Discussionmentioning

confidence: 99%

“…Bradycardia was defined as HR≤50 beats/min (Kinsella and Tuckey, 2001), while tachycardia was defined as HR≥100 beats/min (Kurokochi, 2001). SpO 2 <90% was diagnosed with hypoxemia (Rozé et al, 2011;de Graaff et al, 2013). The adverse reactions such as vomiting and aspiration during the induction period were also recorded.…”

Section: Data Collectionmentioning

confidence: 99%

全麻诱导期经静脉输液管缓慢滴注和快速输注芬太尼对该药诱发呛咳的影响

Liu

Han

et al. 2017

J. Zhejiang Univ. Sci. B

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Abstract:Objective: Fentanyl-induced cough (FIC) is a common complication with a reported incidence from 18.0% to 74.4% during general anesthesia induction. FIC increases the intrathoracic pressure and risks of postoperative nausea and vomiting, yet available treatments are limited. This study was designed to investigate whether administering fentanyl via a slow intravenous fluid line can effectively alleviate FIC during induction of total intravenous general anesthesia. Methods: A total number of 1200 patients, aged 18-64 years, were enrolled, all of whom were American Society of Anesthesiologists (ASA) grade I or II undergoing scheduled surgeries. All patients received total intravenous general anesthesia, which was induced sequentially by midazolam, fentanyl, propofol, and cisatracurium injection. Patients were randomly assigned to receive fentanyl 3.5 μg/kg via direct injection (control group) or via a slow intravenous fluid line. FIC incidence and the severity grades were analyzed with the Mann-Whitney test. Other adverse reactions, such as hypotension, hypertension, bradycardia, tachycardia, hypoxemia, vomiting, and aspiration, during induction were also observed. The online clinical registration number of this study was ChiCTR-IOR-16009025. Results: Compared with the control group, the incidence of FIC was significantly lower in the slow intravenous fluid line group during induction (9.1%, 95% confidence interval (CI): 6.7%-11.4% vs. 55.9%, 95% CI: 51.8%-60.0%, P=0.000), as were the severity grades (P=0.000). There were no statistical differences between the two groups with regard to other adverse reactions (P>0.05). Conclusions: The administration of fentanyl via a slow intravenous fluid line can alleviate FIC and its severity during induction for total intravenous general anesthesia. This method is simple, safe, and reliable, and deserves clinical expansion.

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“…45,46 In brief, initial interventions consist of increasing the F I O 2 , confirming lung isolation, ensuring adequate cardiac output, and using recruitment maneuvers to the ventilated lung. If desaturation is not resolved with initial interventions, application of continuous positive airway pressure (CPAP) to the operative lung or intermittent TLV may be used, realizing that it may interfere with surgical exposure and progress.…”

Section: Management Of Hypoxemiamentioning

confidence: 99%

Step-by-step clinical management of one-lung ventilation: Continuing Professional Development

Brassard

Lohser

Donati

et al. 2014

Can J Anesth/J Can Anesth

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Case Scenario: Management of Intraoperative Hypoxemia during One-lung Ventilation

Cited by 51 publications

References 57 publications

Effects of Stellate Ganglion Block on the Peri-operative Vasomotor Cytokine Content and Intrapulmonary Shunt in Patients with Esophagus Cancer

Effects of Stellate Ganglion Block on the Peri-operative Vasomotor Cytokine Content and Intrapulmonary Shunt in Patients with Esophagus Cancer

全麻诱导期经静脉输液管缓慢滴注和快速输注芬太尼对该药诱发呛咳的影响

Step-by-step clinical management of one-lung ventilation: Continuing Professional Development

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