The effects of remifentanil and thoracic epidural on oxygenation and pulmonary shunt fraction during one-lung ventilation.
OBJECTIVE
To compare the effects of remifentanil and thoracic epidural analgesia on the hemodynamic changes and pulmonary shunt fraction during one-lung ventilation (OLV) for thoracotomy.


METHODS
Prospective, single crossover design.


METHODS
Tertiary care hospital.


METHODS
Thirty-four patients undergoing OLV for thoracic surgery.


METHODS
During general anesthesia with 2-lung ventilation, one-lung ventilation with remifentanil infusion, and one-lung ventilation with thoracic epidural anesthesia (TEA), hemodynamic parameters and arterial and mixed venous blood gases were taken from the radial and pulmonary artery catheters. During these 3 study periods, cardiac index (CI) was measured using thermodilution technique while shunt fraction (Qs/Qt), alveolar arterial oxygen gradient (A-a O(2)), and systemic (SVRI) and pulmonary vascular resistances indices (PVRI) were calculated. A p value <0.05 was taken to be statistically significant.


RESULTS
When OLV was instituted, there was a significant decrease in mean arterial blood pressure. Arterial oxygenation decreased, whereas CI and Qs/Qt increased during OLV, but there was no significant difference between remifentanil infusion and thoracic epidural analgesia.


CONCLUSIONS
Both remifentanil infusion and TEA are suitable for analgesia during thoracic surgery when OLV is used. There was no significant difference in PaO(2) and Qs/Qt during each administration.
Chow
Mark Yew-Hoong
MY
Department of Anaesthesia and Surgical Intensive Care Unit, Singapore General Hospital, Singapore. markchow@bigfoot.com
Goh
Meng-Huat
MH
Boey
Sek Koon
SK
Thirugnanam
Agasthian
A
Ip-Yam
Pierre Christian
PC
D015360:Analgesia, Epidural / Q000706:statistics & numerical data*; D000701:Analgesics, Opioid / Q000494:pharmacology*; D000768:Anesthesia, General / Q000706:statistics & numerical data; D001784:Blood Gas Analysis / Q000706:statistics & numerical data; D018592:Cross-Over Studies; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood*; D010880:Piperidines / Q000494:pharmacology*; D011446:Prospective Studies; D011652:Pulmonary Circulation / Q000502:physiology*; D000077208:Remifentanil; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D013908:Thoracotomy
D000701:Analgesics, Opioid; D010880:Piperidines; D000077208:Remifentanil; D010100:Oxygen