Izvorni znanstveni članak
https://doi.org/10.22514/SV132.112017.8
Hypoxia during one lung ventilation in thoracic surgery
GORDANA TALESKA
; Department of anesthesia and perioperative intensive therapy, University Medical Centre, Ljubljana, Slovenia
MARIJA BOZHINOVSKA
ALEKSANDRA GAVRILOVSKA-BRZANOV
ANITA KOKAREVA
ANITA POPOVSKA
TRAJANKA TRAJKOVSKA
MAJA SOSTARIC
Sažetak
Background. The technique of one lung
ventilation (OLV) is used with the purpose
of achieving isolation of the diseased
lung being operated upon, using a doublelumen
endobronchial tube. Thoracic surgical
procedures which are performed in the
lateral decubitus position, nowadays could
not be imagined without OLV. In spite of
advantages regarding surgical exposure,
OLV is associated with serious respiratory
impairment. Hypoxemia is considered to
be the most important challenge during
OLV. The goal of this study was to establish
the magnitude of intrapulmonary shunt, as
well as the immensity of hypoxia during
general anesthesia with OLV.
Materials and Methods. In this prospective
interventional clinical study thirty patients
were enrolled who underwent elective
thoracic surgery with a prolonged period
of OLV. The patients received balanced
general anesthesia with fentanyl/propofol/
rocuronium. A double-lumen endobronchial
tube was inserted in all patients, and
mechanical ventilation with 50% oxygen in
air was used during the entire study. Arterial
blood gases were recorded in a lateral
decubitus position with two-lung ventilation,
at the beginning of OLV (OLV 0)
and at 10 and 30 min. (OLV 10, OLV 30,
respectively) after initiating OLV in all
patients. Standard monitoring procedures
were used. Arterial oxygenation (PaO2),
arterial oxygen saturation (SaO2) and venous
admixture percentage - intrapulmonary
shunt (Qs/Qt %) were measured, as
well as mean arterial pressure and heart
rate during the same time intervals. For
the purpose of this study, the quantitative
value of Qs/Qt% was mathematically calculated
using the blood gas analyser AVL
Compact 3. A p value <0.05 was taken to
be statistically significant.
Results. When OLV was instituted, arterial
oxygenation decreased, whereas Qs/Qt%
increased, about 10 min. after commencement,
with improvement of oxygenation
approximately half an hour afterwards. A
statistically relevant difference (p<0.05)
occurred in PaO2, SaO2 and Qs/Qt at the
different time points.
Conclusion. Hypoxia during OLV, with an
increase in Qs/Qt, usually occurs after 10
min. of its initiation. After 30 min, the values
of the Qs/Qt ratio regularly return to
normal levels.
Ključne riječi
one-lung ventilation; thoracic surgery; venous admixture; intrapulmonary shunt
Hrčak ID:
190596
URI
Datum izdavanja:
12.12.2017.
Posjeta: 1.276 *