Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine, Gifu, Japan.
Innovative and Clinical Research Promotion Center, Gifu University Hospital, Gifu, Japan.
Medicine (Baltimore). 2022 Oct 14;101(41):e30030. doi: 10.1097/MD.0000000000030030.
During one-lung ventilation (OLV), deterioration of pulmonary oxygenation reduces arterial oxygen saturation and cerebral oxygen saturation (rSO2). However, oxidative stress during OLV causes lung injury, so the fraction of inspiratory oxygen (FiO2) should be kept as low as possible. We investigated the changes in rSO2 under propofol or desflurane anesthesia while percutaneous oxygen saturation (SpO2) was kept as low as possible during OLV.
Thirty-six patients scheduled for thoracic surgery under OLV in the lateral decubitus position were randomly assigned to propofol (n = 19) or desflurane (n = 17) anesthesia. FiO2 was set to 0.4 at the start of surgery under two-lung ventilation (measurement point: T3) and then adjusted to maintain an SpO2 of 92% to 94% after the initiation of OLV. The primary outcome was the difference in the absolute value of the decrease in rSO2 from T3 to 30 minutes after the initiation of OLV (T5), which was analyzed by an analysis of covariance adjusted for the rSO2 value at T3.
The mean rSO2 values were 61.5% ± 5.1% at T3 and 57.1% ± 5.3% at T5 in the propofol group and 62.2% ± 6.0% at T3 and 58.6% ± 5.3% at T5 in the desflurane group. The difference in the absolute value of decrease between groups (propofol group - desflurane group) was 0.95 (95% confidence interval, [-0.32, 2.2]; P = .152).
Both propofol and desflurane anesthesia maintain comparable cerebral oxygenation and can be used safely, even when the SpO2 is kept as low as possible during OLV.
在单肺通气（OLV）期间，肺氧合恶化会降低动脉血氧饱和度和脑氧饱和度（rSO2）。然而，OLV 期间的氧化应激会导致肺损伤，因此应尽可能保持吸入氧分数（FiO2）较低。我们研究了在保持 OLV 期间经皮血氧饱和度（SpO2）尽可能低的情况下，丙泊酚或地氟醚麻醉下 rSO2 的变化。
36 例拟在侧卧位行 OLV 下的胸科手术患者，随机分为丙泊酚（n = 19）或地氟醚（n = 17）麻醉组。在双肺通气下手术开始时 FiO2 设置为 0.4（测量点：T3），然后调整 FiO2 以维持 OLV 开始后 SpO2 为 92%至 94%。主要结局是从 T3 到 OLV 开始后 30 分钟（T5）rSO2 绝对值下降的差异，用调整 T3 时 rSO2 值的协方差分析进行分析。
丙泊酚组 T3 时 rSO2 平均值为 61.5%±5.1%，T5 时为 57.1%±5.3%；地氟醚组 T3 时 rSO2 平均值为 62.2%±6.0%，T5 时为 58.6%±5.3%。两组间绝对值下降的差异（丙泊酚组-地氟醚组）为 0.95（95%置信区间，[-0.32，2.2]；P =.152）。
即使在 OLV 期间将 SpO2 保持尽可能低的水平，丙泊酚和地氟醚麻醉都能维持相似的脑氧合，并且可以安全使用。
