Effects of one-lung ventilation on pulmonary hemodynamics and gas exchange in the newborn.
For major thoracoscopic surgery, one-lung ventilation is mandatory. This is reasonably well tolerated in adults and children. The effects of one-lung ventilation on hemodynamics and gas exchange in newborns, however, are not known yet. Eight neonatal domestic pigs with a median age of 6 days (range: 3-9 days), and a mean body weight of 2.3 kg (1.7-2.8 kg) were intubated and ventilated in pressure-controlled mode (FIO2 = 1). Anesthesia was maintained with i.v. fentanyl/metomidate. After tracheotomy an endotracheal tube was positioned in the trachea, and a second tube in the left mainstem bronchus. One-lung ventilation was maintained for 120 min. Serial measurements were done before, during, and until 90 min. after one-lung ventilation. During one-lung ventilation, pulmonary artery pressure and intrapulmonary shunt increased from 15 +/- 1 to 18 +/- 1 mmHg (p = 0.004), and from 2.6 +/- 0.3 to 3.7 +/- 0.4% (p = 0.02), respectively. Arterial oxygen saturation remained unchanged at 100%. A slight increase in arterial PCO2 could easily be treated by increasing the respiratory rate. In conclusion, one-lung ventilation was not associated with major side effects in regard to hemodynamics and gas exchange in the neonatal pig.
Tönz
M
M
Clinic for Pediatric Surgery, University Hospital Bern, Switzerland.
Bachmann
D
D
Mettler
D
D
Kaiser
G
G
D000328:Adult; D000818:Animals; D000831:Animals, Newborn; D002245:Carbon Dioxide / Q000097:blood; D002648:Child; D019723:Endoscopes; D005240:Feasibility Studies; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007231:Infant, Newborn; D008168:Lung / Q000098:blood supply*; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D011175:Positive-Pressure Respiration / Q000295:instrumentation*; D011659:Pulmonary Gas Exchange / Q000502:physiology*; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D013552:Swine; D020708:Thoracoscopes; D014741:Video Recording / Q000295:instrumentation
D002245:Carbon Dioxide