One-Lung Anesthesia

Rees, D. Ian; Wansbrough, Scott R.

doi:10.1213/00000539-198206000-00006

Cited by 22 publications

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“…Alveolar hypoxia induces inflammation and the use of AOI to maintain a certain swelling of the lung can delay the occurrence of lung injury [15]. After using AOI, even during the period of lung collapse, some of the alveoli remain unobstructed with the proximal airway, increasing the non-ventilated side oxygen concentration [16], facilitating gas exchange and reducing pulmonary shunt during OLV [17]. The results of this study suggest that Patients of both groups have varying degrees of decline in oxygenation function after OLV, which is consistent with previous literature.…”

Section: Discussionmentioning

confidence: 99%

Can apneic oxygen insufflation become a novel lung protective ventilation strategy? A randomized, controlled, blinded, single center clinical trial

et al. 2018

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ObjectiveThe aim of this study was to determine whether a AOI strategy on non-ventilated lung could reduce the regional and systemic proinflammatory cytokine and oxidative stress response associated with esophagectomy, and to evaluate whether AOI can be used as a novel lung protective ventilation strategy. Its impact on oxygenation after OLV, surfactant protein A, B, C (SP-A, B, C), postoperative hospital stay and postoperative pulmonary complications (PPCs) was also evaluated.MethodsFifty-four adults (ASA II-III) undergoing esophagectomy with OLV were enrolled in the study. Patients were randomly assigned into 2 groups: control group (group C) and treated group (group T). Group C was treated with traditional OLV mode,while group T was given AOI of 5 L/min oxygen on the non-ventilated lung immediately at the beginning of OLV. Arterial blood gas was analyzed before and after OLV. A bronchoalveolar lavage(BAL) was performed after OLV on the non-ventilated lung. Proinflammatory cytokine, oxidative stress markers(TNF-α, NF-κB,sICAM-1,IL-6,IL-10,SOD,MDA) and SP-A, B, C were analyzed in serum and BALF as the primary endpoint.The clinical outcome determined by PPCs was assessed as the secondary endpoint.ResultsPatients with AOI had better oxygenation in the recovery period, oxygenation index(OI) (394[367–426] and 478[440–497]mmHg, respectively) of group T at T2 and T3 were significantly higher than those (332[206–434] and 437[331–512]mmHg, respectively) of group C. OLV resulted in an increase in the measured inflammatory markers in both groups, however, the increase of inflammatory markers upon OLV in the group C was significantly higher than those of group T. OLV resulted in an increase in the measured SP-A, B, C in serum of both groups. However, the levels of SP-A, B, C of group T were lower than those of group C in serum after OLV, and the results in BALF were the opposite. The BALF levels of SOD(23.88[14.70–33.93]U/ml) of group T were higher than those(15.99[10.33–24.16] U/ml) of group C, while the levels of MDA in both serum and BALF of group T(8.60[4.14–9.85] and 1.88[1.33–3.08]nmol/ml, respectively) were all lower than those of group C (11.10[6.57–13.75] and 1.280[1.01–1.83]nmol/ml) after OLV. There was no statistical difference between the two groups in terms of postoperative hospital stay and the incidence of PPCs.ConclusionAOI on non-ventilated lung during OLV can improve the oxygenation function after OLV, relieve the inflammatory and oxidative stress response in the systemic and non-ventilated lung after OLV associated with esophagectomy.Trial registrationChiCTR-IOR-17011037. Registered on 31 March 2017.

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Section: Discussionmentioning

confidence: 99%

Can apneic oxygen insufflation become a novel lung protective ventilation strategy? A randomized, controlled, blinded, single center clinical trial

et al. 2018

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“…5,6) 그러나 일측 폐환기 시 동맥혈 산소분압감소가 나타날 수 있는데, 유의한 저산소혈증이 일측 폐환기로 폐 수술을 하는 환자의 40-50%에서 발생한다고 보고되었다. 7,8) 이것 은 환기가 이루어지지 않는 비 의존적 폐를 통한 우좌 폐 단락이 발생하기 때문으로, 5,9) 대략 30%의 단락이 발생하는 것으로 알려져 있다. [10][11][12][13] 동맥혈 산소분압을 유지하기 위해 저산소성 폐혈관수축이 나타나지만 그 효과가 완전하지 않 고 수술 중 여러 인자에 의해 영향을 받는다.…”

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Decrease in Arterial Oxygen Partial Pressure by Pleural Opening in Thoracotomy during One-Lung Ventilation

Kim

Sin

Jung

et al. 2005

Korean J Anesthesiol

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Background: One-lung ventilation (OLV) is commonly used in the majority of thoracotomies and thoracoscopic surgeries. During OLV, a decrease in partial pressure of arterial oxygen (PaO2) occurs due to the right-to-left transpulmonary shunt that develops in the non-dependent lung, and is aggravated just after pleural opening. Here, we examined the occurrence, cause, and means of preventing drops in PaO2 caused by pleural opening.Methods: Seventy patients, ASA PS I or II, who were scheduled for elective thoracotomy or thoracoscopic surgery, were prospectively examined. After OLV, patients were randomly allocated to one of four groups. In the Control group (n = 10), pleurae were not opened during studies. In the Open group (n = 20), pleurae were opened with the plug of the double-lumen endobronchial tube of the non-dependent lung opened. In the Closure group (n = 20), the plug was closed just before pleural opening. And in the continuous positive airway pressure (CPAP) group (n = 20), pleurae were opened after applying 5 cmH2O CPAP of medical air to the non-dependent lung. Arterial blood gas analyses, hemodynamics, end-tidal CO2, peak inspiratory airway pressure, lung compliance, and airway resistance were recorded 15 min after two-lung ventilation, 20 min after transition to OLV, just before pleural opening, and 1, 3, and 20 min after pleural opening. In the control group, data were recorded 15 min after two-lung ventilation and in seven intervals after transition to OLV (1, 3, 5, 10, 20, 25, and 45 min).Results: A significant decrease in PaO2 was detected just after pleural opening in the Open and Closure groups. PaO2 decreased in the Open group more than in the Closure group. However, in the CPAP group, no significant PaO2 reduction was detected after pleural opening.Conclusions: We found that PaO2 decreased when pleurae were opened during OLV. This may be due to the sudden development of atelectasis in the non-dependent lung by exposure to atmospheric pressure. This decrease in PaO2 can be relieved by closing the double-lumen endobronchial tube's plug of the non-dependent lung or by applying CPAP to the non-dependent lung when pleurae are opened.

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Con: Application of constant positive airway pressure to the nondependent lung is not preferable to high-frequency ventilation to optimize oxygenation during pulmonary surgery

El-Baz

1987

Journal of Cardiothoracic Anesthesia

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One-Lung Anesthesia

Cited by 22 publications

References 0 publications

Can apneic oxygen insufflation become a novel lung protective ventilation strategy? A randomized, controlled, blinded, single center clinical trial

Can apneic oxygen insufflation become a novel lung protective ventilation strategy? A randomized, controlled, blinded, single center clinical trial

Decrease in Arterial Oxygen Partial Pressure by Pleural Opening in Thoracotomy during One-Lung Ventilation

Con: Application of constant positive airway pressure to the nondependent lung is not preferable to high-frequency ventilation to optimize oxygenation during pulmonary surgery

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