title: Effects of sevoflurane and propofol on pulmonary shunt fraction during one-lung ventilation for thoracic surgery.
abstract: Forty patients requiring one-lung ventilation (OLV) for thoracic surgery were randomly assigned to receive propofol (4-6 mg kg(-1) h(-1)) or sevoflurane (1 MAC) for maintenance of anaesthesia. Three sets of measurements were taken: (i) after 30 min of two-lung ventilation (TLV), (ii) after 30 min of one-lung ventilation (OLV-1) in the supine position and (iii) during OLV in the lateral position (OLV-2) with the chest open and before surgical manipulation of the lung. There were no differences between groups in patient characteristics or preoperative condition. Increases in shunt fraction during OLV-1 were 17.4% and 17.2% (P=0.94), those during OLV-2 were 18.3% and 16.5% (P=0.59) for the propofol and sevoflurane group, respectively. Cardiac index and other haemodynamic and respiratory variables were similar for the two groups. We conclude that inhibition of hypoxic pulmonary vasoconstriction by sevoflurane may only account for small increases in shunt fraction and that much of the overall shunt fraction during OLV has other causes.
authors.affiliation: Universitätsklinik Charité, Abteilung für Anaesthesiologie und operative Intensivmedizin, Berlin, Germany.
authors.forename: D H
authors.initials: DH
authors.lastname: Beck
authors.forename: U R
authors.initials: UR
authors.lastname: Doepfmer
authors.forename: C
authors.initials: C
authors.lastname: Sinemus
authors.forename: A
authors.initials: A
authors.lastname: Bloch
authors.forename: M R
authors.initials: MR
authors.lastname: Schenk
authors.forename: W J
authors.initials: WJ
authors.lastname: Kox
mesh_terms: D000328:Adult; D000368:Aged; D018685:Anesthetics, Inhalation / Q000494:pharmacology*; D018686:Anesthetics, Intravenous / Q000494:pharmacology*; D002245:Carbon Dioxide / Q000097:blood; D002302:Cardiac Output / Q000187:drug effects; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000494:pharmacology*; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D015742:Propofol / Q000494:pharmacology*; D011652:Pulmonary Circulation / Q000187:drug effects; D012121:Respiration, Artificial / Q000379:methods*; D000077149:Sevoflurane; D020775:Thoracic Surgery, Video-Assisted; D019616:Thoracic Surgical Procedures
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D002245:Carbon Dioxide; D000077149:Sevoflurane; D010100:Oxygen; D015742:Propofol