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Arterial oxygenation during one-lung ventilation: combined versus general anesthesia
I Garutti1, B Quintana, L Olmedilla
1Service of Anesthesiology and Reanimation, Hospital General Gregorio Marañón, Madrid, Spain.
Anesthesia and Analgesia
|March 11, 1999
Summary
General i.v. anesthesia (propofol-fentanyl) provided superior arterial oxygenation (PaO2) during one-lung ventilation (OLV) compared to thoracic epidural anesthesia (TEA) in lung surgery patients. TEA was associated with increased intrapulmonary shunting.
Area of Science:
- Anesthesiology
- Thoracic Surgery
- Pulmonary Medicine
Background:
- Optimal anesthetic management for thoracotomy and pulmonary resection remains undetermined.
- One-lung ventilation (OLV) is critical during thoracic surgery but can compromise gas exchange.
Purpose of the Study:
- To compare arterial oxygen tension (PaO2) during OLV between general intravenous anesthesia (GA) and thoracic epidural anesthesia (TEA) with supplemental anesthetics.
- To evaluate intrapulmonary shunting during OLV under different anesthetic techniques.
Main Methods:
- 60 patients undergoing elective lung cancer surgery with prolonged OLV were randomized into GA (propofol-fentanyl) or TEA (propofol/rocuronium/epidural bupivacaine) groups.
- Mechanical ventilation with 100% oxygen was used throughout.
- Arterial blood gases and oxygenation parameters were measured at baseline and during OLV.
Main Results:
- The GA group demonstrated significantly higher PaO2 at 15 and 30 minutes into OLV compared to the TEA group (175/182 mmHg vs. 120/118 mmHg).
- The TEA group exhibited a significantly increased venous admixture percentage (Qs/Qt%), indicating greater intrapulmonary shunting.
- No other significant differences in oxygenation parameters were observed between groups.
Conclusions:
- Thoracic epidural anesthesia, when combined with general anesthesia, is associated with poorer arterial oxygenation and increased intrapulmonary shunting during prolonged OLV.
- Total intravenous anesthesia alone may offer superior oxygenation during one-lung ventilation in thoracic surgery.