ABSTRACT
Objective: To investigate the effect of epidural anesthesia combined with inhalation or intravenous anesthesia on intrapulmonary shunt and oxygenation in patients undergoing long term single lung ventilation
Methods: Eighty patients, aged 35-75, American Society of Anesthesiology [ASA] classification of I-III, undergoing thoracic surgery with one lung ventilation more than three hour, were randomly divided into propofol group [group Pro], propofol combined with epidural anesthesia group [group Pro+Epi], isoflurane group [group Iso] and isoflurane combined with epidural anesthesia group [group Iso+ Epi], 20 patients in each group. Arterial blood and mixed venous blood were taken for blood gas analysis, and hemodynamic data were recorded at following time points: before induction in supine position [T1], 30min after bilateral lung ventilation [T2], 15min after one lung ventilation [T3], 30min after one lung ventilation [T4], 60min after one lung ventilation [T5], 180min after one lung ventilation [T6], intrapulmonary shunt [Qs/Qt] was calculated according to the correlation formula
Results: Qs/Qt values at T2-6 in four groups were significantly higher than that of T1, and Qs/Qt values at T3-6 was significantly higher than that of T2 [P< 0.05]; PaO2 at T2-6 were significantly higher than that of T1, with PaO2 at T3-6 were significantly lower than T2 [P< 0.05]. Between groups, Qs/Qt values in group Iso were significantly higher than that of group Pro, Pro+Epi and Iso+Epi at T3-5 [P< 0.05]. There was no significant difference in PaO2 between groups [P> 0.05]. CI at T3-6 in group Iso and Iso+Epi were significantly higher than that of T1 [P<0.05], and were significantly higher than that of propofol group [P<0.05]. MAP at T3-6 in group Pro+Epi and Iso+Epi were significantly lower than that at T1 [P <0.05]. Heart rate at T4-6 in group Iso were significantly higher than T1, and higher than group Pro and group Iso+Epi [P <0.05]
Conclusion: One lung ventilation may predispose to increase of intrapulmonary shunt and decrease in arterial partial pressure of oxygen; isoflurane inhalation anesthesia is more likely to cause intrapulmonary shunt, but no changes in arterial partial pressure of oxygen
ABSTRACT
Objective: Goal-directed fluid therapy [GDFT] was associated with improved outcomes after surgery. Noninvasive Cardiac Output Monitoring [NICOM] has proved to be a good choice for guiding GDFT. This study evaluated the effect of GDFT based on NICOM on prognosis in elderly patients undergoing resection of gastrointestinal tumor
Methods: Fifty patients scheduled for elective laparoscopic radical resection for stomach, colon or rectal cancer in Yongchuan Hospital of Chongqing Medical University between November 2014 and December 2015 were included and randomly divided into two groups: conventional fluid therapy [group C, n=25] and goal-directed fluid therapy [group G, n=25]. The primary outcome was moderate or severe postoperative complications within 30 days
Results: Finally, 45 patients successfully completed the study [group G, n=22; group C, n=23]. There were no difference of the duration of surgery, the requirement of vasoactive agents and the bleeding volume between two groups [P>0.05]. Total fluids infused were 2956 +/- 629 ml [group C] and 2259 +/- 454 ml [group G] [P<0.05], while the requirement of colloid was increased in group G [1103 +/- 285ml vs 855 +/- 226ml] [P<0.05]. The MAP and the mean CI were higher in group G [P<0.05]. Compared with group C, the time when the patients passed the flatus and the length of hospital stay after operation were shortened in group G [12.6 +/- 2.4 day vs17.2 +/- 2.6 day], the incidence of postoperative complications were significantly lower in group G [P<0.05]
Conclusions: Goal-directed fluid therapy based on NICOM was significantly associated with improvement of prognosis in elderly patients undergoing resection of gastrointestinal tumor which reduced postoperative complications