Khddam Ayham, Rostom Faten, Hajeer Mohammad Y
Department of Anesthesia and Resuscitation, Children's Hospital, University of Damascus, Damascus, SYR.
Department of Anesthesia, Faculty of Medicine, University of Damascus, Damascus, SYR.
Cureus. 2024 Sep 18;16(9):e69659. doi: 10.7759/cureus.69659. eCollection 2024 Sep.
Background and objectives Pediatric thoracic surgery has unique considerations due to the immaturity of the respiratory system anatomically and physiologically, which presents technical and pharmacological considerations, including the very common technique of one-lung ventilation (OLV), which causes serious complications in children. Therefore, we investigated the effects of dexmedetomidine on oxygenation and pulmonary shunt fraction (Qs/Qt) in high-risk pediatric patients undergoing OLV for thoracic surgery. This randomized controlled trial aimed to investigate dexmedetomidine's effect on the partial pressure of arterial oxygen (PaO) and pulmonary shunt fraction (Qs/Qt). Methods A total of 63 children underwent thoracic surgery with OLV and were divided into two groups. The dexmedetomidine group (group Dex, n = 32) received dexmedetomidine (0.4 μg/kg/hour), and the placebo group (group placebo, n = 31) received normal saline. Two arterial and central venous blood samples were taken for arterial and venous blood gas analysis at four time points: T1 (10 minutes after mechanical ventilation of total lung ventilation), T2 (10 minutes after OLV), T3 (60 minutes after OLV), and T4 (20 minutes after the end of OLV). At these intervals, the following parameters were measured: PaO, Qs/Qt, mean arterial pressure (MAP), heart rate (HR), and peak inspiratory pressure (PIP). Results The two groups had no significant differences in FEV1/FVC and baseline pulmonary shunt fraction (Qs/Qt). Dexmedetomidine significantly improved PaO compared with placebo during OLV (T2 and T3). There was a significant decrease in Qs/Qt compared with placebo during OLV (T2, T3, and T4). There was a decrease in PIP compared with placebo during OLV (T2 and T3). No statistically significant differences in MAP or HR were observed between the groups. Conclusion Infusion of dexmedetomidine during OLV in high-risk pediatric thoracic surgery reduces shunt and pulmonary shunt fraction Qs/Qt, improves PaO and body oxygenation, reduces PIP and pressure load, and maintains hemodynamic stability (MAP, HR).
背景与目的 由于呼吸系统在解剖学和生理学上的不成熟，小儿胸外科手术有其独特的考量因素，这带来了技术和药理学方面的问题，包括非常常见的单肺通气（OLV）技术，该技术在儿童中会引发严重并发症。因此，我们研究了右美托咪定对接受胸外科手术OLV的高危儿科患者氧合及肺分流分数（Qs/Qt）的影响。这项随机对照试验旨在研究右美托咪定对动脉血氧分压（PaO）和肺分流分数（Qs/Qt）的影响。方法 共有63例接受OLV胸外科手术的儿童被分为两组。右美托咪定组（Dex组，n = 32）接受右美托咪定（0.4μg/kg/小时），安慰剂组（安慰剂组，n = 31）接受生理盐水。在四个时间点采集两份动脉和中心静脉血样本进行动脉和静脉血气分析：T1（双肺通气机械通气10分钟后）、T2（OLV 10分钟后）、T3（OLV 60分钟后）和T4（OLV结束20分钟后）。在这些时间间隔内，测量以下参数：PaO、Qs/Qt、平均动脉压（MAP）、心率（HR）和吸气峰压（PIP）。结果 两组在FEV1/FVC和基线肺分流分数（Qs/Qt）方面无显著差异。与安慰剂相比，右美托咪定在OLV期间（T2和T3）显著改善了PaO。与安慰剂相比，OLV期间（T2、T3和T4）Qs/Qt显著降低。与安慰剂相比，OLV期间（T2和T3）PIP降低。两组之间在MAP或HR方面未观察到统计学显著差异。结论 在高危小儿胸外科手术OLV期间输注右美托咪定可降低分流和肺分流分数Qs/Qt，改善PaO和机体氧合，降低PIP和压力负荷，并维持血流动力学稳定性（MAP、HR）。
