Effect of Dexmedetomidine Combined with Inhalation of Isoflurane on Oxygenation Following One-Lung Ventilation in Thoracic Surgery

Somayeh Asri, Hamzeh Hosseinzadeh, Mahmood Eydi, Marzieh Marahem, Abbasali Dehghani, Hassan Soleimanpour, Somayeh Asri, Hamzeh Hosseinzadeh, Mahmood Eydi, Marzieh Marahem, Abbasali Dehghani, Hassan Soleimanpour

Abstract

Background: One-lung ventilation (OLV) is commonly used during thoracic surgery. At this time, hypoxemia is considered one of the remarkable consequences of the anesthesia management. Hypoxic pulmonary vasoconstriction (HPV) is the defense mechanism against hypoxia.

Objectives: The aim of the present study was to investigate the effect of infusion of dexmedetomidine on improving the oxygenation during OLV among the adult patients undergoing thoracic surgery.

Methods: A total of 42 patients undergoing OLV by general anesthesia with isoflurane inhalation were randomly assigned into two groups: IV infusion of dexmedetomidine at 0.3 microgram/kg/h (DISO) and IV infusion of normal saline (NISO). Three Arterial Blood Gas (ABG) samples were obtained throughout the surgery. Hemodynamic parameters, PaO2, PaCO2, and complications at recovery phase were recorded. The collected information was analyzed using SPSS software version 22.

Results: In the dexmedetomidine group, the mean hemodynamic parameters had a significant reduction at 30 and 60 minutes following OLV. Administration of dexmedetomidine resulted in a significant increase in the PaCO2 and a reduction in the PaO2 when changing from two-lung ventilation to OLV, where PaO2 reached its maximum value within 10 minutes after OLV in the DISO group, and it began to gradually increase to the end of operation. The duration of the recovery phase, also complications at the recovery phase decreased significantly in DISO group.

Conclusions: The results of the study showed that, dexmedetomidine may improve arterial oxygenation during OLV in adult patients undergoing thoracic surgery, and can be a suitable anesthetic agent for thoracic surgery.

Keywords: Dexmedetomidine; Hypoxic Pulmonary Vasoconstriction; One-Lung Ventilation; Thoracic Surgery.

Conflict of interest statement

Conflict of Interests: The authors declared no conflict of interest.

Copyright © 2020, Author(s).

References

    1. Sheybani S, Attar AS, Golshan S, Sheibani S, Rajabian M. Effect of propofol and isoflurane on gas exchange parameters following one-lung ventilation in thoracic surgery: A double-blinded randomized controlled clinical trial. Electron Physician. 2018;10(2):6346–53. doi: 10.19082/6346.
    1. Karzai W, Schwarzkopf K. Hypoxemia during one-lung ventilation: Prediction, prevention, and treatment. Anesthesiology. 2009;110(6):1402–11. doi: 10.1097/ALN.0b013e31819fb15d.
    1. Huang SQ, Zhang J, Zhang XX, Liu L, Yu Y, Kang XH, et al. Can dexmedetomidine improve arterial oxygenation and intrapulmonary shunt during one-lung ventilation in adults undergoing thoracic surgery? A meta-analysis of randomized, placebo-controlled trials. Chin Med J (Engl). 2017;130(14):1707–14. doi: 10.4103/0366-6999.209891.
    1. Lee JH, Kim H, Kim HT, Kim MH, Cho K, Lim SH, et al. Comparison of dexmedetomidine and remifentanil for attenuation of hemodynamic responses to laryngoscopy and tracheal intubation. Korean J Anesthesiol. 2012;63(2):124–9. doi: 10.4097/kjae.2012.63.2.124.
    1. Xia R, Yin H, Xia ZY, Mao QJ, Chen GD, Xu W. Effect of intravenous infusion of dexmedetomidine combined with inhalation of isoflurane on arterial oxygenation and intrapulmonary shunt during single-lung ventilation. Cell Biochem Biophys. 2013;67(3):1547–50. doi: 10.1007/s12013-013-9659-8.
    1. Lee SH, Kim N, Lee CY, Ban MG, Oh YJ. Effects of dexmedetomidine on oxygenation and lung mechanics in patients with moderate chronic obstructive pulmonary disease undergoing lung cancer surgery: A randomised double-blinded trial. Eur J Anaesthesiol. 2016;33(4):275–82. doi: 10.1097/EJA.0000000000000405.
    1. Hickey T. One-lung ventilation. In: Aglio L, Urman R, editors. Anesthesiology. Springer, Cham; 2017.
    1. Can M, Gul S, Bektas S, Hanci V, Acikgoz S. Effects of dexmedetomidine or methylprednisolone on inflammatory responses in spinal cord injury. Acta Anaesthesiol Scand. 2009;53(8):1068–72. doi: 10.1111/j.1399-6576.2009.02019.x.
    1. Lumb AB, Slinger P. Hypoxic pulmonary vasoconstriction: Physiology and anesthetic implications. Anesthesiology. 2015;122(4):932–46. doi: 10.1097/ALN.0000000000000569.
    1. Tarry D, Powell M. Hypoxic pulmonary vasoconstriction. BJA Education. 2017;17(6):208–13. doi: 10.1093/bjaed/mkw076.
    1. Bhana N, Goa KL, McClellan KJ. Dexmedetomidine. Drugs. 2000;59(2):263–8. doi: 10.2165/00003495-200059020-00012. discussion 269-70.
    1. Coughlan MG, Lee JG, Bosnjak ZJ, Schmeling WT, Kampine JP, Warltier DC. Direct coronary and cerebral vascular responses to dexmedetomidine. Significance of endogenous nitric oxide synthesis. Anesthesiology. 1992;77(5):998–1006. doi: 10.1097/00000542-199211000-00024.
    1. Blake DW. Dexmedetomidine and hemodynamic responses to simulated hemorrhage in experimental heart failure. Anesth Analg. 2000;91(5):1112–7. doi: 10.1097/00000539-200011000-00012.
    1. Buget MI, Sungur Z, Ozkan B, Yornuk M, Demircan F, Senturk M. The effect of dexmedetomidine on oxygenation and intrapulmonary shunt during one lung ventilation. Open Journal of Anesthesiology. 2015;05(07):135–41. doi: 10.4236/ojanes.2015.57025.
    1. Xia R, Xu J, Yin H, Wu H, Xia Z, Zhou D, et al. Intravenous infusion of dexmedetomidine combined isoflurane inhalation reduces oxidative stress and potentiates hypoxia pulmonary vasoconstriction during one-lung ventilation in patients. Mediators Inflamm. 2015;2015:238041. doi: 10.1155/2015/238041.
    1. Tanskanen PE, Kytta JV, Randell TT, Aantaa RE. Dexmedetomidine as an anaesthetic adjuvant in patients undergoing intracranial tumour surgery: A double-blind, randomized and placebo-controlled study. Br J Anaesth. 2006;97(5):658–65. doi: 10.1093/bja/ael220.
    1. Amano E, Tateda T, Inoue S. Asystole during administration of dexmedetomidine with spinal anesthesia: A case report. J St Marianna Univ. 2018;9(2):81–5. doi: 10.17264/stmarieng.9.81.
    1. Kernan S, Rehman S, Meyer T, Bourbeau J, Caron N, Tobias JD. Effects of dexmedetomidine on oxygenation during one-lung ventilation for thoracic surgery in adults. J Minim Access Surg. 2011;7(4):227–31. doi: 10.4103/0972-9941.85645.
    1. Abe K, Shimizu T, Takashina M, Shiozaki H, Yoshiya I. The effects of propofol, isoflurane, and sevoflurane on oxygenation and shunt fraction during one-lung ventilation. Anesth Analg. 1998;87(5):1164–9. doi: 10.1097/00000539-199811000-00035.
    1. Wang JY, Russell GN, Page RD, Oo A, Pennefather SH. A comparison of the effects of desflurane and isoflurane on arterial oxygenation during one-lung ventilation. Anaesthesia. 2000;55(2):167–73. doi: 10.1046/j.1365-2044.2000.055002167.x.
    1. Lee SH, Lee CY, Lee JG, Kim N, Lee HM, Oh YJ. Intraoperative dexmedetomidine improves the quality of recovery and postoperative pulmonary function in patients undergoing video-assisted thoracoscopic surgery: A CONSORT-prospective, randomized, controlled trial. Medicine (Baltimore). 2016;95(7):e2854. doi: 10.1097/MD.0000000000002854.
    1. Le Bot A, Michelet D, Hilly J, Maesani M, Dilly MP, Brasher C, et al. Efficacy of intraoperative dexmedetomidine compared with placebo for surgery in adults: A meta-analysis of published studies. Minerva Anestesiol. 2015;81(10):1105–17.

Source: PubMed

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