title: Almitrine fails to improve oxygenation during one-lung ventilation with sevoflurane anesthesia.
abstract: OBJECTIVE
  Almitrine enhances hypoxic pulmonary vasoconstriction (HPV) and can improve hypoxemia related to one-lung ventilation (OLV). Studies using almitrine have been conducted without inhaled anesthetics because they could inhibit HPV, counteracting the effect of almitrine. This hypothesis, however, has not been confirmed. This study's aim was to evaluate whether almitrine could improve oxygenation when administered during OLV with sevoflurane anesthesia.
  
  
  METHODS
  A prospective, randomized, double-blind, placebo-controlled trial.
  
  
  METHODS
  A tertiary care, university teaching hospital.
  
  
  METHODS
  Thirty adult patients undergoing open-chest thoracic surgery.
  
  
  METHODS
  Patients were assigned randomly to receive almitrine or placebo during OLV. Respiratory and hemodynamic variables were recorded continuously. Anesthesia was maintained with sevoflurane and remifentanil. Intraoperative techniques and medical teams were the same all over the study.
  
  
  RESULTS
  Respiratory and hemodynamic variables were measured during two-lung ventilation and during open-chest OLV. Two-way repeated-measures analysis of variance was used to compare the effects of almitrine and placebo. During OLV, PaO2 and shunt fraction worsened in all patients without significant differences between groups. At 30-minutes of OLV, PaO2 was 184±67 mmHg in the almitrine group and 145±56 mmHg in the placebo group, while shunt fraction were 31%±6% and 36%±13%, respectively. Mean pulmonary artery pressure was higher in the almitrine group (31±5 v 24±5 mmHg, p<0.001).
  
  
  CONCLUSIONS
  During anesthesia with sevoflurane for open-chest OLV, almitrine failed to improve oxygenation and increased pulmonary artery pressure. The combination of sevoflurane and almitrine should, therefore, be avoided.
authors.affiliation: Department of Anesthesiology, Hospital del Mar. Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Bermejo
authors.affiliation: Department of Anesthesiology, Hospital del Mar. Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona, Spain. Electronic address: LGallart@parcdesalutmar.cat.
authors.forename: Lluís
authors.initials: L
authors.lastname: Gallart
authors.affiliation: Department of Anesthesiology, Hospital del Mar. Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Silva-Costa-Gomes
authors.affiliation: Department of Anesthesiology, Hospital del Mar. Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Vallès
authors.affiliation: Department of Thoracic Surgery, Hospital del Mar. Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Aguiló
authors.affiliation: Department of Anesthesiology, Hospital del Mar. Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona, Spain.
authors.forename: Margarita M
authors.initials: MM
authors.lastname: Puig
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015765:Almitrine / Q000008:administration & dosage*; D000768:Anesthesia, General / Q000379:methods*; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D001784:Blood Gas Analysis; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D000860:Hypoxia / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D008168:Lung / Q000378:metabolism / Q000503:physiopathology; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage*; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D061810:One-Lung Ventilation / Q000379:methods*; D010101:Oxygen Consumption / Q000187:drug effects*; D011446:Prospective Studies; D019141:Respiratory System Agents / Q000008:administration & dosage; D000077149:Sevoflurane; D019616:Thoracic Surgical Procedures; D055815:Young Adult
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D019141:Respiratory System Agents; D000077149:Sevoflurane; D015765:Almitrine
keywords: almitrine; hypoxia; one-lung ventilation; pulmonary circulation; sevoflurane; thoracic surgery