Abstract
Hypoxic pulmonary vasoconstriction (HPV) has not been demonstrated in human single lung anaesthesia in the lateral decubitus position (LDP). The purpose of this study was to determine whether (1) HPV occurs in the non-dependent, nonventilated lung, and (2) if the infusion of sodium nitroprusside (SNP) inhibits HPV During intravenous anaesthesia the tracheas of seven patients were intubated with double lumen endotracheal tubes. Standard monitors plus radial and pulmonary arterial catheters were placed. Patients were positioned in the LDP and haemodynamic and gas exchange data were recorded for each of three stages; I: two-lung ventilation, II: single, dependent lung ventilation (1LV) and III: 1LV with infusion of SNP. In stage II the PaO2 decreased from 531 ± 42 mmHg to 285 ± 42 mmHg (P < 0.05) and Qs/Qt increased from 12.3 ± 2.7 to 29.0 ± 6.3% (P < 0.05). With SNP infusion there was a 30% increase in cardiac index (CI) (P < 0.05). The SNP infusion was not associated with changes in Qs/ Qt or PaO2. This model demonstrates changes in Qs/ Qt and PaO2 associated with single-lung ventilation in ASA I and II patients in the LDP but we were unable to demonstrate inhibition of HPV by SNP.
Résumé
En position de décubitus latéral (PDL), l’existence de vasoconstriction hypoxique (VHP) au niveau du poumon isolé n’a pas été démontrée. Cette étude vise à déterminer 1) si la VHP se manifeste au poumon supérieur non ventilé et 2) si une perfusion de nitroprussiate de sodium (SNP) inhibe la VHP Au cours d’une anesthésie intraveineuse, sept patients sont intubés avec un tube à double lumière. Le monitorage habituel est complété d’une canule artérielle et d’un cathéter de Swann-Ganz. Les patients sont placés en PDL et les paramètres hémodynamiques et les échanges gazeux mesurés pour chacun des trois stades de l’étude; stade I: ventilation bipulmonaire; stade II: ventilation unipulmonaire du poumon inférieur (VIP); et stade III: VIP avec perfusion de SNP. Au stade II, la PaO2 s’abaisse de 531 ± 42 mmHg à 285 ± 42 mmHg (P < 0,05) et le Qs/Qt augmente de 12,3 ± 2,7 à 29,0 ± 6,3% (P < 0,05). Pendant la perfusion de SNP, l’index cardiaque augmente de 30% (P < 0,05). La perfusion de SNP ne provoque pas de changements de Qs/Qt, ni de PaO2. Ce modèle montre que des changements de Qs/Qt et de PaO2 se manifestent pendant la ventilation unipulmonaire chez des patients ASA I et II en PDL mais ne montre pas que le SNP inhibe la VHP
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Friedlander, M., Sandler, A., Kavanagh, B. et al. Is hypoxic pulmonary vasoconstriction important during single lung ventilation in the lateral decubitus position?. Can J Anaesth 41, 26–30 (1994). https://doi.org/10.1007/BF03009657
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DOI: https://doi.org/10.1007/BF03009657