Abstract
Purpose
To compare the effects of isoflurane and sevoflurane on artenal oxygenation and middle cerebral artery blood flow velocity during one lung ventilation.
Methods
This was a randomized, crossover study in 20 patients undergoing thoracotomy for oesophageal cancer and scheduled for long term one lung ventilation (OLV). They were randomized to one of two groups: group A. firstly isoflurane was administered followed by sevoflurane, and then isoflurane was resumed; group B. the order of the administration was reversed. Artenal blood gas samples were drawn at the start of OLV, 30 and 60 min after the initiation of OLV and the end of OLV (the change of volatile anesthetics was done 30 and 60 min after the start of OLV). Middle cerebral artery (MCA) was monitored continuously with the probe positioned over the temporal bone window. This probe transmitted 2 MHZ wave Doppler signals. Time-averaged MCA blood flow velocity was calculated from the signals.
Results
The PaO values decreased 30 min after the start of OLV (364.4 ±33.4 mmHg vs 179.0 ± 19.5, and 338.7 ± 24.8 mmHg vs 139.7 ± 19.9 in groups A and B respectively), but there was no difference between the groups. Blood flow velocity of MCA did not change after the start of OLV (53.1 ± 3.2, 55.9 ± 3.0. 56.4 ± 2.4, and 54.1 ± 1.9 vs 50.8 ± 2.1, 50.7 ± 2.4, 53.7 ± 1.5, 50.8 ± 2.2 cm · sec−1 in groups A and B respectively): there was no difference between the groups. (P < 0.05).
Conclusion
In clinical practice, the selection of either isoflurane and sevoflurane for OLV was of no difference in terms of the artena 1 blood oxygenation. With both agents MCA blood flow velocity was maintained during OLV.
Résumé
Objectif
Comparer les effets de l’isoflurane et du sévoflurane sur l’oxygénation arténelle et la vélocité du débit de l’artère cérébrale moyenne pendant la ventilation unipulmonaire.
Méthodes
Cette étude aléatoire avec croisement regroupait 20 sujets thoracotomisés pour un cancer de l’oesophage et programinés pour une ventilation unipulmonaire (VUP) prolongée. Ils ont été répartis au hasard en deux groupes: le groupe A recevait de l’isoflurane suivi du sévoflurane et de l’isoflurane à nouveau; dans le groupe B, l’ordre des agerts était inversé. Des échantillons de sang étaient prélevés pour la gazométne arténelle au début de la VUP, 30 et 60 min plus tard, et à la fin de la VUP (l’échange d’anesthésique volatil survenait 30 et 60 min après l’initiation de la VUP) Un capteur placé sur l’os temporal permettait de monitorer l’artère cérébrale moyenne (ACM) en continu par la transmission d’ondes Doppler de 2 MHZ Ces signaux ont servi au calcul de la moyenne de la vélocité du débit de l’ACM en fonction du temps.
Résultats
Les valeurs de la PaO2 ont diminué 30 min après le début de la VUP (respectivement dans les groupes A et B; 364,4 ± 33,4 mmHg à 179,0 ± 19,5 et 338,7 ± 24,8 mmHg à 139,7 ± 19,9) mais sans différence intergroupe La vélocité sanguine de l’ACM n’a pas changé après la mise en marche de la VUP (respectivement dans les groupes A et B; 53,1 t 3,2; 55,9 ± 3,0: 56,4 ± 2,4 et 54,1 ± 1,9 vs 50,8 ± 2,1; 50,7 ± 2,4; 53,7 ± 1,5: 50,8 ± 2,2 cm · s−1); il n’y a pas eu de différence entre les groupes (P < 0,05).
Conclusion
En clinique, le choix de l’isoflurane ou du sévoflurane pour la VUP n’influence pas l’oxygénation artérielle Le débit sanguin de l’ACM se maintient pendant la VUP avec l’un et l’autre des agents.
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Shimizu, T., Abe, K., Kinouchi, K. et al. Arterial oxygenation during one lung ventilation. Can J Anesth 44, 1162–1166 (1997). https://doi.org/10.1007/BF03013338
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DOI: https://doi.org/10.1007/BF03013338