title: The effect of epidural dexmedetomidine on oxygenation and shunt fraction in patients undergoing thoracotomy and one lung ventilation: A randomized controlled study.
abstract: OBJECTIVE
  Role of epidural dexmedetomidine in providing analgesia is well documented, but its effect on oxygenation and shunt fraction is not well established. We studied the hypothesis that epidural dexmedetomidine may improve oxygenation and shunt fraction during one-lung ventilation (OLV).
  
  
  METHODS
  After taking Institutional Ethics Committee approval, sixty patients undergoing thoracotomy and OLV were randomized to receive epidural ropivacaine with saline (RS group) or epidural ropivacaine with dexmedetomidine (RD group). Group RS received 7 ml of ropivacaine 0.5% with 1.5 ml normal saline (NS) bolus while RD group received 7 ml of 0.5% ropivacaine with 1 mcg/kg dexmedetomidine reconstituted in 1.5 ml NS. This was followed by infusion of 5 ml/h of 0.5% ropivacaine in RS group and 5 ml/h of 0.5% ropivacaine containing 0.2 mcg/kg of dexmedetomidine in RD group. Arterial and central venous blood gas parameters were obtained 15 minutes after intubation during two lung ventilation (TLV15), 15 and 45 min after OLV (OLV15, OLV45) and 15 minutes after reinstitution of two lung ventilation (ReTLV).
  
  
  RESULTS
  RD group had better oxygenation (254.2 ± 72.3 mmHg, 240.60 ± 59.26 mmHg) as compared to RS group (215.2 ± 64.3 mmHg, 190.7 ± 61.48 mmHg) at OLV15 (P- 0.04) and OLV45 (P- 0.004) respectively. Shunt fraction in RD group was (30.31 ± 7.89%, 33.76 ± 8.89%) and (35.14 ± 7.58%, 39.57 ± 13.03%) in RS group at OLV15 and OLV45, respectively. The increase in the shunt fraction from TLV15 was significantly greater in RS group than RD group both at OLV15 (P- 0.03) and OLV45 (P- 0.03). The sevoflurane and fentanyl requirement was lower in RD group.
  
  
  CONCLUSIONS
  Epidural dexmedetomidine improves oxygenation and reduces shunt fraction during OLV, in patients undergoing thoracotomy. It also reduces intraoperative anesthetic and analgesic requirement.
authors.affiliation: Department of Anesthesia and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
authors.forename: Prachi
authors.initials: P
authors.lastname: Kar
authors.affiliation: Department of Anesthesia and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
authors.forename: Padmaja
authors.initials: P
authors.lastname: Durga
authors.affiliation: Department of Anesthesia and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
authors.forename: Ramachandran
authors.initials: R
authors.lastname: Gopinath
keywords: Dexmedetomidine; one lung ventilation; oxygenation; shunt fraction; thoracotomy