The effect of hypercapnia and hypertension on cerebral oxygen balance during one-lung ventilation for lung surgery during propofol anesthesia

Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan.
Journal of clinical anesthesia (Impact Factor: 1.19). 12/2010; 22(8):608-13. DOI: 10.1016/j.jclinane.2010.05.006
Source: PubMed


To investigate whether jugular bulb venous oxygen saturation (SjO(2)) values increased with induced hypercapnia or induced hypertension during propofol-based anesthesia for one-lung ventilation (OLV).
Prospective clinical study.
Operating room at University hospital.
15 adult patients scheduled for elective thoracic procedures in the lateral position.
General anesthesia was maintained with propofol combined with epidural anesthesia. During OLV, hypercapnia (PaCO(2) = 50 mmHg) and hypertension (20% increase in mean arterial pressure) were applied.
SjO2 values were measured.
With hypercapnia, SjO(2) values increased 30 ± 18% (from 54.3 ± 8.8% to 69.3 ± 6.3%). With hypertension, SjO(2) values were increased by 9 ± 18% (from 54.4 ± 9.0% to 58.5 ± 8.8%). These changes were significantly different. No significant differences regarding SaO(2) were observed during OLV in the experimental period.
Hypercapnia, not hypertension, significantly improved cerebral oxygen balance without observed side effects during propofol anesthesia.

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    ABSTRACT: Aim: Our aim was to show the effect of one-lung ventilation (OLV) on cerebral blood flow (CBF) by measuring carotid blood flow. This technique has been the subject of experimental and clinical studies. Materials and methods: Carotid doppler flows were measured at 4 different times. Peak systolic velocity (PSV) and end diastolic velocity (EDV) were measured and pulsatility index (PI) and resistive index (RI) calculated. Results: There were no significant changes in PSV, PI, RI, or flow volume in the normal or diseased sides at repeated measures (P > 0.05).There was no significant difference between the flow velocities, PIs, RIs, or flow volumes measured in the supine and decubitus positions during OLV. In addition, there was no significant difference between the flow parameters of the upper and lower carotids measured in the lateral decubitus position before and after OLV. There was no correlation between any of the flow parameters and duration of OLV. Conclusion: OLV poses no additional risk in terms of CBF. However, further studies, supported by biochemical parameters and involving wider patient groups, are now needed.
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