Effect of dexmedetomidine on intrapulmonary shunt in patients with sevoflurane maintained during one-lung ventilation: A case–control study

Wang, Yewen; Gong, Chao; Yu, F. Richard; Zhang, Quanyi

doi:10.1097/md.0000000000031818

Cited by 4 publications

(3 citation statements)

References 24 publications

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“…We did not find similar studies in children; only one similar study was conducted in adults [22]. Wang et al administered a loading dose of 0.75 µg/kg over 10 minutes, followed by a maintenance dose of 0.3 µg/kg/hour, and made measurements over three periods to determine the effect of dexmedetomidine [22]. The results showed that his shunt improved, as the Qs/Qt ratio was reduced with a statistically significant difference, but his oxygen transport (PaO2) was not significantly affected.…”

Section: Discussionmentioning

confidence: 73%

“…We have used dexmedetomidine with sevoflurane as an inhalation anesthetic in thoracic surgeries in children in whom single lung ventilation (OLV) is performed. We did not find similar studies in children; only one similar study was conducted in adults [22]. Wang et al administered a loading dose of 0.75 µg/kg over 10 minutes, followed by a maintenance dose of 0.3 µg/kg/hour, and made measurements over three periods to determine the effect of dexmedetomidine [22].…”

Section: Discussionmentioning

confidence: 90%

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Effect of Dexmedetomidine on Oxygen and Intrapulmonary Shunt (Qs/Qt) During One-Lung Ventilation in Pediatric Surgery: A Randomized Controlled Trial

Khddam,

Rostom,

Hajeer

2024

Cureus

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BackgroundOne-lung ventilation (OLV) is a common ventilation technique used during thoracic surgery. It can cause serious complications in children, and hypoxic pulmonary vasoconstriction (HPV) is a protective mechanism against the resulting hypoxia. Dexmedetomidine does not affect HPV, so we will investigate its impact on the partial pressure of oxygen in arterial blood (PaO2) and pulmonary shunt fraction (Qs/Qt). MethodsChildren who underwent OLV were divided into two equal groups. The Dex group received 0.4 μg/kg/h of dexmedetomidine intravenously. The placebo group received normal saline. Two blood samples were taken to analyze arterial and central venous blood gasses during four time periods: T1, 10 minutes after anesthesia; T2, 10 minutes after OLV; T3, 60 minutes after OLV; and T4, 20 minutes after the end of OLV. Heart rate, mean arterial pressure (MAP), PaO2, Qs/Qt, and peak inspiratory pressure (PIP) values were recorded at these time points. ResultsRegarding heart rate, the Dex group remained relatively stable, whereas the placebo group showed a slight increase in T3 and T4. Concerning MAP, the Dex group had a reduction at T1 compared with the placebo group and remained similar for other points. PaO2 decreased with OLV. However, the Dex group consistently maintained higher PaO2 values than the placebo, especially in T3 and T4. Concerning Qs/Qt, the Dex group maintained lower time values than the placebo group at OLV. Regarding PIP, the Dex group had significantly lower T2 and T3 than the placebo group. ConclusionAdministration of dexmedetomidine in children with OLV improves PaO2 and reduces pulmonary shunt fraction (Qs/Qt), thereby improving oxygen transport. It reduces the maximum PIP values, thereby reducing pressure-related complications.

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 90%

Effect of Dexmedetomidine on Oxygen and Intrapulmonary Shunt (Qs/Qt) During One-Lung Ventilation in Pediatric Surgery: A Randomized Controlled Trial

Khddam,

Rostom,

Hajeer

2024

Cureus

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“…More specifically, dexmedetomidine can raise vagal nerve tone that partially contributed to its anti-inflammatory and lungprotective effects (Li et al 2022). Dexmedetomidine may improve intrapulmonary shunt and arterial oxygenation during one-lung ventilation (OLV) in adults receiving thoracic surgery (Huang et al 2017;Wang et al 2022). The improved oxygenation results in less demand of volatile anesthetic (isoflurane) agents in patients receiving dexmedetomidine (Asri et al 2020).…”

Section: Introductionmentioning

confidence: 99%

Effect of dexmedetomidine on pulmonary function in obese patients undergoing laparoscopic surgery

Chen,

Wang,

Zhang

et al. 2024

Perioper Med

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Objective This research aimed to ascertain the effect of dexmedetomidine on pulmonary function in obese patients undergoing laparoscopic surgery. Methods Obese patients undergoing laparoscopic surgery under general anesthesia were separated into the control group (group C) and the dexmedetomidine group (group D) (n = 30). Patients in group D were infused with dexmedetomidine (1 μg/kg) intravenously for 10 min and then at a rate of 0.5 mg/kg h until 30 min before the end of the surgery, and those in group C were infused with an equal volume of saline. The surgery time points were divided into: before anesthesia induction (T0), 5 min after intubation (T1), 30 min after pneumoperitoneum (T2), 10 min after pneumoperitoneum release (T3), at the time of extubation (T4), 3 min after extubation (T5), and 24 h after surgery (T6). Arterial blood was collected for blood gas analysis to record arterial partial pressure of oxygen (PaO2) and arterial partial pressure of carbon dioxide (PaCO2). Dynamic lung compliance (Cdyn), oxygenation index (OI), alveolar-arterial oxygen partial pressure difference (A-aDO2), and respiratory index (RI) were calculated. The time of surgery, anesthesia, CO2 pneumoperitoneum, eye-opening, and time from the end of surgery to extubation were recorded. Plasma IL-8 and IL-10 levels were measured from T0 to T6. Results The time of surgery, anesthesia, CO2 pneumoperitoneum, eye-opening, and time from the end of surgery to extubation in group D were not statistically significant when compared with those in group C. Versus at the T1 time point, A-aDO2 and RI were higher and Cdyn and OI were lower in both groups at T2 and T3 time points. Versus group C, group D had higher Cdyn and OI and lower A-aDO2 and RI at T2 and T3 time points. Versus at the T0 time point, at each time point from T1 to T6, IL-8 and IL-10 levels were higher in both groups. Versus group C, group D had lower IL-8 and higher IL-10 levels at each time point from T1 to T6. Conclusion In obese patients undergoing laparoscopic surgery under general anesthesia, the use of dexmedetomidine can improve the lung compliance and OI of the patients, inhibit the inflammatory response of the lungs of the patients and thus have a certain protective effect on the lung function.

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Effect of Dexmedetomidine in Video-Assisted Thoracoscopic Surgery: A Randomized Controlled Study

Zhikharev,

Bushuev,

Arutyunyan

et al. 2024

Innovacionnaâ medicina Kubani

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Background: One-lung ventilation is used to improve surgical visualization and facilitate thoracoscopic manipulations; however, it induces ventilation/perfusion mismatch, exacerbating the inflammatory response that causes hypoxemia in the perioperative period. Opioid analgesics are the main analgesic drugs used during video-assisted thoracoscopic surgery (VATS), but their use is associated with adverse effects and higher risk of respiratory complications. Corrective measures to eliminate hypoxemia, reduce the inflammatory response, control pain, and minimize opioid-induced adverse effects are crucial in thoracic surgery.Objective: To study the efficacy of dexmedetomidine in reducing lung damage and postoperative complications after VATS.Materials and methods: We examined 100 patients who underwent lobectomy via a thoracoscopic approach. The patients were grouped based on anesthetic management: group 1 (n = 50) with intraoperative dexmedetomidine and group 2 (n = 50) without it. We determined the level of pro-inflammatory cytokines IL-6, IL-8, and TNF and calculated PaO2/FiO2 and A-aDO2. We also assessed the postoperative pain intensity, need for trimeperidin promedol and tramadol, and incidence of postoperative complications.Results: During one-lung ventilation, patients from group 1 had higher PaO2/FiO2 values (P = .025). The A-aDO2 value was higher in group 2 (P = .006). After surgery, we found differences in the content of TNF and IL-8 (P < .001). Twenty-four hours after surgery, we recorded a more significant prevalence of the studied cytokines in group 2 (P < .001). There were no significant differences in the pain dynamics on the first postoperative day (P > .05). Opioid analgesics were less needed in group 1 than in group 2 (P < .001). The incidence of postoperative complications did not differ significantly.Conclusions: Dexmedetomidine in thoracic surgery improves the oxygenation and reduces the percentage of intrapulmonary shunting by inhibiting the release of pro-inflammatory cytokines. In the postoperative period, dexmedetomidine reduces the need for opioid analgesics, but does not affect the pain level or incidence of complications.

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Effect of dexmedetomidine on intrapulmonary shunt in patients with sevoflurane maintained during one-lung ventilation: A case–control study

Cited by 4 publications

References 24 publications

Effect of Dexmedetomidine on Oxygen and Intrapulmonary Shunt (Qs/Qt) During One-Lung Ventilation in Pediatric Surgery: A Randomized Controlled Trial

Effect of Dexmedetomidine on Oxygen and Intrapulmonary Shunt (Qs/Qt) During One-Lung Ventilation in Pediatric Surgery: A Randomized Controlled Trial

Effect of dexmedetomidine on pulmonary function in obese patients undergoing laparoscopic surgery

Effect of Dexmedetomidine in Video-Assisted Thoracoscopic Surgery: A Randomized Controlled Study

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