Effect of desflurane-remifentanil vs. Propofol-remifentanil anesthesia on arterial oxygenation during one-lung ventilation for thoracoscopic surgery: a prospective randomized trial

Abstract

BackgroundOne-lung ventilation during thoracic surgery frequently disturbs normal systemic oxygenation. However, the effect of anesthetics on arterial oxygenation during one-lung ventilation has not been well established in human study. In this clinical trial, we investigated whether a difference between desflurane-remifentanil and propofol-remifentanil anesthesia can be observed with regard to oxygenation during one-lung ventilation for thoracoscopic surgery.MethodsAdult patients with lung cancer, scheduled for video-assisted thoracoscopic lobectomy without preoperative oxygen support, were screened and randomized to receive desflurane or propofol, with remifentanil continuous infusion in both groups. Mechanical ventilation was performed with tidal volume of 8 ml/kg and FIO2 0.5 during two-lung ventilation, and 6 ml/kg and 1.0 during one-lung ventilation, both with positive end-expiratory pressure of 5 cmH2O. Arterial blood gas analysis was performed preoperatively, during two-lung ventilation, and after 15, 30, 45, and 60 min of one-lung ventilation. The primary endpoint was PaO2 at 30 min after initiating one-lung ventilation. Statistical analyses included the independent t-test for the primary endpoint and a mixed model with a post-hoc analysis to evaluate the serial changes in values.ResultsPatients were recruited between July 9 and December 2, 2014. In total, 103 patients were analyzed (n = 52 in desflurane group and n = 51 in propofol group). The primary endpoint, PaO2 at 30 min of one-lung ventilation was lower in the desflurane group than the propofol group (170 ± 72 vs. 202 ± 82 mmHg; p = 0.039). Serial changes in PaO2 during one-lung ventilation showed lower levels during desflurane anesthesia compared with propofol anesthesia (mean difference, 45 mmHg; 95% confidence interval, 16–75 mmHg; p = 0.003).ConclusionsIn conclusion, desflurane-remifentanil anesthesia resulted in decreased arterial oxygenation compared with that of propofol-remifentanil anesthesia during one-lung ventilation for thoracoscopic surgery in patients with lung cancer.Trial registrationClinicalTrials.gov identifier: NCT02191371, registered on July 7, 2014

The Consumption of Anesthetic Agents During One-lung Ventilation and a Cost Analysis: a Comparison of Two Techniques

“…Desflurane and propofol are the anesthetic agents most preferred due to their short-acting properties with a low blood-gas partition coefficient and low context-sensitive halftime, respectively. [19] An animal study revealed that desflurane depressed hypoxic pulmonary vasoconstriction in a dose-dependent manner and impaired oxygenation during OLV. [20] Chao et al [19] also indicated that the administration of propofolremifentanil TIVA might be a better choice in preventing hypoxemia during OLV compared with desflurane-remifentanil balanced anesthesia.…”

“…[19] An animal study revealed that desflurane depressed hypoxic pulmonary vasoconstriction in a dose-dependent manner and impaired oxygenation during OLV. [20] Chao et al [19] also indicated that the administration of propofolremifentanil TIVA might be a better choice in preventing hypoxemia during OLV compared with desflurane-remifentanil balanced anesthesia. Cardiac output, the arterial partial pressure of oxygen (PaO 2 ) and mixed venous PO 2 also decreased with desflurane inhalation, whereas perfusion of the non-ventilated lung and shunt fraction remained comparable with the propofol infusion in an animal model.…”

Effect of Intravenous Propofol and Inhaled Sevoflurane Anesthesia on Postoperative Spirometric Indices: A Randomized Controlled Trial

“…Patients with severe cardiovascular diseases, CHF, COPD, chest deformity, drug abuse, BMI > 35, and history of anticonvulsant agent consumption were excluded from the study. Considering a 95% confidence interval, 80% power, and based on a similar study (27), the minimum sample size in each group was calculated as 55 patients. Using a permuted block randomization, the enrolled patients were divided into two groups of propofol and sevoflurane.…”

Effect of propofol and isoflurane on gas exchange parameters following one-lung ventilation in thoracic surgery: a double-blinded randomized controlled clinical trial

“…The degree of hypoxemia during OLV is mainly influenced by the increase in the shunt and dead space ( 4 ). In fact, pulmonary arteriovenous fistula due to the presence of unsaturated blood is the most important cause of hypoxemia during OLV; hypoxic pulmonary vasoconstriction (HPV) is the major physiological defense mechanism against shunting ( 5 , 6 ). Based on this mechanism, pulmonary perfusion deviates from the unvented area to the ventilated area of the lung, and thus the unsaturated blood shunt is reduced and the hypoxemia is improved ( 5 – 7 ).…”

“…The two main drug categories for the maintenance of anesthesia, including propofol (intravenous) and isoflurane (inhalational), are relatively new anesthetics that have rapid onset and offset due to low blood/gas partition coefficient and context-sensitive half-life. However, their effect on HPV and subsequently on partial pressures of oxygen (PaO2), carbon dioxide (PaCO2), and end-tidal carbon dioxide (ETCO2) has not yet been well studied ( 2 , 5 , 6 , 12 ). Although it seems that the vasoconstrictive effect of inhalational anesthetics can affect the protective role of HPV and may interfere with the oxygenation during the OLV, the recent studies on the effect of inhalational and intravenous anesthetics on PaO2 have revealed contradictory findings (5, 13 and 14).…”