Abstract
This study was undertaken to examine the effect of sevoflurane on right ventricular junction, the safety of sevoflurane for onelung ventilation and the effects of PEEP (positive end-expiratory pressure) to the dependent lung in this model using 12 openchest sheep. Haemodynamic variables, including cardiac output, mean arterial blood pressure, right ventricular pressure and pulmonary arterial pressure, and right ventricular segment shortening (sonomicrometry) were measured. First, animals received 2.0, 3.0 or 4.0% sevoflurane for 20 min each, respectively, during two-lung ventilation to measure the dose-dependent haemodynamic effects of sevoflurane. Then one-lung ventilation was performed with a randomized sequence of 0 (ZEEP), 5 and 10 cm H2O PEEP to the dependent lung under 2.0% sevoflurane anaesthesia after one-hour stabilization. A decrease in systolic segment shortening along with increases in both the end-diastolic and end-systolic lengths of the right ventricle were observed at 3.0 and 4.0% sevoflurane, while global right ventricular function remained substantially unchanged during twolung ventilation. During one-lung ventilation the PaO2 was greater with 5 cm H2O PEEP 198 mmHg (± 25 SEM) than with ZEEP 138 mmHg (± 22) or with 10 cm H2O PEEP 153 mmHg (± 23) (P < 0.05). No differences in haemodynamic variables or segment shortening between ZEEP and PEEPs during one-lung ventilation were observed. We conclude that although sevoflurane causes a dose-dependent depression of right ventricular function, sevoflurane anaesthesia can be safely applied to one-lung ventilation, and that 5 cm H2O PEEP to the dependent lung can improve arterial oxygenation without causing changes in right ventricular function.
Résumé
Ce travail vise à évaluer les effets du sévoflurane sur la fonction ventriculaire droite, sa sécurité en ventilation monopulmonaire et les effets de la pression positive télé-expiratoire (PEEP) sur le poumon inférieur à thorax ouvert chez 12 moutons. On mesure les variables hémodynamiques habituelles: débit cardiaque, pression artérielle moyenne, pression ventriculaire droite, pression artérielle pulmonaire; et par sonomicrométrie, le raccourcissement segmentaire ventriculaire droit. D’abord, les animaux sont anesthésiés au sévoflurane à 2,0, 3,0, or 4,0% pour 20 minutes pendant la ventilation bipulmonaire pour mesurer les effets hémodynamiques du sévoflurane. Ensuite, la ventilation monopulmonaire est initiée avec une séquence randomisée de 0 (ZEEP), 5 et 10 cm H2O PEEP sur le poumon inférieur et maintenue à une concentration de sévoflurane 2% pour une période de stabilisation d’une heure. Une diminution du raccourcissement systolique segmentaire droit et un allongement télédiastolique et télésystolique ventriculaire droit simultanés sont observés sous sévoflurane 3,0 et 4,0%. La fonction ventriculaire droite globale demeure inchangée pendant la ventilation bipulmonaire. Pendant la ventilation monopulmonaire, la PaO2 est plus élevée sous PEEP 5 cm H2O (198 mmHg ± 25 SEM) que sous ZEEP (138 mmHg ± 22) ou sous PEEP 10 cm H2O (153 mmHg ± 23) (P < 0,05). On n’observe pas de différences entre les diverses variables hémodynamiques et au regard du raccourcissement segmentaire entre le ZEEP et le PEEP pendant la ventilation monopulmonaire. Nous concluons que bien que le sévoflurane puisse produire une dépression de la fonction ventriculaire droite proportionnelle à la dose, le sévoflurane peut être utilisé avec sécurité pour la ventilation monopulmonaire et qu’une PEEP de 5 cm H2O appliquée au poumon inférieur peut améliorer l’oxygénation artérielle sans modifier la fonction ventriculaire droite.
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This study was performed in the Department of Anesthesiology, Kawasaki Medical School.
This study was supported in part by Kawasaki Medical School Project Grant #4-105.
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Fujita, Y., Yamasaki, T., Takaori, M. et al. Sevoflurane anaesthesia for one-lung ventilation with PEEP to the dependent lung in sheep: effects on right ventricular function and oxygenation. Can J Anaesth 40, 1195–1200 (1993). https://doi.org/10.1007/BF03009609
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DOI: https://doi.org/10.1007/BF03009609