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Continuous ketamine infusion for one-lung anaesthesia
Canadian Anaesthetists' Society Journal
|September 1, 1980
Summary
Ketamine infusion effectively maintains oxygenation during one-lung anesthesia, preserving hypoxic pulmonary vasoconstriction. This intravenous anesthetic is a viable alternative to volatile agents for lung surgery patients.
Area of Science:
- Anesthesiology
- Pulmonary Medicine
- Cardiovascular Physiology
Background:
- Hypoxic pulmonary vasoconstriction (HPV) normally optimizes blood flow to ventilated lung areas.
- Volatile anesthetics can impair HPV, potentially worsening blood-gas exchange during lung surgery.
- Intravenous anesthetics, unlike volatile agents, do not abolish the HPV reflex.
Purpose of the Study:
- To evaluate the efficacy of continuous ketamine infusion during one-lung anesthesia.
- To assess ketamine's effect on oxygenation (PaO2) and shunt fraction in patients undergoing pulmonary resection.
- To determine if ketamine preserves HPV, unlike volatile anesthetics.
Main Methods:
- A study involving 110 patients undergoing elective pulmonary resection.
- Continuous infusion of ketamine for one-lung anesthesia.
- Monitoring of PaO2 and shunt fraction at varying inspired oxygen fractions (FIO2 0.5 and 1.0).
Main Results:
- Ketamine infusion maintained PaO2 above 9.31 kPa (70 torr) with FIO2 1.0.
- Shunt fraction increased from 25.9% (FIO2 0.5) to 36.0% (FIO2 1.0), indicating preserved HPV.
- Ketamine provided analgesia and hypnosis, allowing high oxygen concentrations without recall concerns.
Conclusions:
- Continuous ketamine infusion is a satisfactory alternative to volatile agents for one-lung anesthesia.
- Ketamine preserves HPV, which is crucial for managing oxygenation in patients undergoing lung surgery.
- This approach is beneficial for patients where relative hypoxemia is unacceptable during surgery.