The effect of thoracic epidural anesthesia on pulmonary shunt fraction and arterial oxygenation during one-lung ventilation.
OBJECTIVE
To compare the effect of thoracic epidural local anesthetic, epidural opioid, and intravenous opioid on pulmonary shunt fraction, arterial oxygenation, and hemodynamic changes during one-lung ventilation (OLV) in patients undergoing thoracic surgery.


METHODS
A prospective, randomized, double-blind study.


METHODS
A university hospital.


METHODS
Thirty-nine patients undergoing OLV for pulmonary resection.


METHODS
Patients were randomized into 1 of 3 groups: epidural bupivacaine (TEA-B group, n = 13), epidural sufentanil (TEA-S group, n = 13), or intravenous remifentanil (IV-R group, n = 13) during general anesthesia with propofol. A double-lumen tube was inserted, and mechanical ventilation with 100% oxygen was used in the lateral decubitus position.


RESULTS
Hemodynamic variables and arterial and mixed venous blood gas analysis from the radial and pulmonary artery catheter were measured and shunt fraction was calculated during two-lung ventilation (TLV), 15, 30, and 60 minutes after the initiation of OLV, and 15 minutes after the reinstitution of TLV. Although mean arterial pressures 15 and 30 minutes after OLV in the IV-R group were significantly higher than the value in TEA-S group, cardiac output and pulmonary vascular resistance were maintained. Decreases in PaO(2), SaO(2), PvO(2), and SvO(2) and an increase in the shunt fraction after OLV were not different among groups and returned to baseline value after the resumption of TLV.


CONCLUSIONS
Thoracic epidural bupivacaine, epidural sufentanil, and intravenous remifentanil-combined general intravenous anesthesia have comparable effects on shunt fraction and arterial oxygenation during OLV in patients undergoing thoracic surgery.
Jung
Sung Mee
SM
Department of Anesthesiology, Konyang University Hospital, Daejeon, Korea. applejsm@hotmail.com
Cho
Choon Kyu
CK
Kim
Young Jin
YJ
Cho
Hyun Min
HM
Kim
Chul-Woung
CW
Kwon
Hee Uk
HU
Kim
Eung Kyun
EK
Park
Jeong Min
JM
D000328:Adult; D000368:Aged; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D000771:Anesthesia, Intravenous; D000779:Anesthetics, Local; D001784:Blood Gas Analysis; D002045:Bupivacaine; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008168:Lung / Q000378:metabolism* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood*; D011292:Premedication; D012121:Respiration, Artificial; D012129:Respiratory Function Tests; D019616:Thoracic Surgical Procedures
D000779:Anesthetics, Local; D010100:Oxygen; D002045:Bupivacaine