Factors Affecting the Occurrence of Hypoxemia During One-Lung Ventilation

Introduction: Hypoxemia that occurs during one-lung ventilation (OLV) in thoracic surgery increases the risk of perioperative and postoperative complications, affecting mortality and morbidity. The aim of this study is to analyze the occurrence of perioperative hypoxemia (SpO₂ ≤ 90%) and to determine whether preoperative spirometry results and arterial blood gas analyses influence its development. Materials and Methods: In this retrospective study, we evaluated 80 elective patients who underwent lung resection (segmentectomy, lobectomy, bilobectomy, pneumonectomy) due to malignancy under one-lung ventilation. The patients had ASA I-III, EF >50%, FEV₁ >40%, and PaO₂ >60 mmHg. We administered anesthesia in accordance with a standard protocol. We excluded patients under the age of 18, those with pathological arrhythmias, metastatic changes in the contralateral lung, endocrine disorders, renal or hepatic dysfunction, coagulation disorders, or those who had previously undergone radiotherapy or chemotherapy. We evaluated demographic, clinical, and surgical data, with a special focus on the results of preoperative spirometry and blood gas analyses and their correlation with the occurrence of desaturation (SpO2 ≤ 90%), which was measured every 10 minutes from the start of OLV. Results: Desaturation had the highest percentage of occurrences 20 minutes after the initiation of OLV (27.5%). It was more common in patients with right-sided surgery, patients with FEV₁% ≥ 70 and FVC%≥70, and in overweight patients (BMI ≥ 25). Conclusion: The risk factors for hypoxemia during one-lung ventilation in thoracic surgery include right-sided surgery, which poses higher anatomical challenges for oxygenation, and pulmonary function values such as FEV and FVC at or above 70 percent. Additionally, a higher body mass index (BMI) is a key predictor of oxygen saturation drops. These factors highlight the need for careful preoperative assessment to manage oxygenation effectively.