Pagel P S, Fu J L, Damask M C, Davis R F, Samuelson P N, Howie M B, Warltier D C
Department of Anesthesiology, Medical College of Wisconsin and the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee 53226, USA.
Anesth Analg. 1998 Oct;87(4):800-7. doi: 10.1097/00000539-199810000-00011.
We tested the hypothesis that desflurane (DES) and isoflurane (ISO) produce similar effects on systemic and pulmonary hemodynamics and arterial oxygenation before, during, and after one-lung ventilation (OLV) in patients undergoing thoracotomy. After obtaining informed consent, anesthesia was induced with sodium thiopental or thiamylal, fentanyl, and vecuronium in 61 ASA physical status II-IV patients. Patients were randomly assigned to receive either DES (n = 30) or ISO (n = 31) in 100% O2 in separate groups. Hemodynamic data (radial and pulmonary artery [PA] catheters) were recorded, and blood gas values were obtained before and after induction; at selected intervals before, during, and after OLV; and before emergence. DES significantly (P < 0.05) increased heart rate (HR) and decreased mean arterial pressure (MAP) and cardiac output (CO). PA pressures and pulmonary vascular resistance (PVR) increased; systemic vascular resistance (SVR) was unchanged. Increases in HR and CO and decreases in MAP and SVR occurred during OLV and DES. Reductions in PaO2 (411 +/- 88 to 271 +/- 131 mm Hg 5 min after beginning OLV; mean +/- SD) and content (CaO2) and increases in shunt fraction (Qs/Qt; 0.25 +/- 0.12 to 0.40 +/- 0.19 at 5 min after beginning OLV) were also observed. ISO increased HR and PA pressures but did not alter MAP, CO, and PVR, in contrast to the findings with DES. Reductions in MAP and SVR and increases in CO and PA pressures were observed during OLV in the presence of ISO. Similar to the findings during DES, decreases in PaO2 and CaO2 and increases in Qs/Qt occurred during OLV and ISO. We conclude that DES and ISO produce very similar alterations in systemic and pulmonary hemodynamics and arterial oxygenation in patients undergoing OLV during thoracotomy.
Desflurane and isoflurane produce similar cardiovascular and pulmonary effects before, during, and after one-lung ventilation in patients undergoing lung surgery.
我们检验了以下假设：在开胸手术患者单肺通气（OLV）前、期间及之后，地氟烷（DES）和异氟烷（ISO）对全身和肺血流动力学及动脉氧合产生相似的影响。在获得知情同意后，对61例美国麻醉医师协会（ASA）身体状况为II - IV级的患者，用硫喷妥钠或硫戊巴比妥、芬太尼和维库溴铵诱导麻醉。患者被随机分为两组，分别在100%氧气中接受DES（n = 30）或ISO（n = 31）。记录血流动力学数据（桡动脉和肺动脉[PA]导管），并在诱导前和诱导后；OLV前、期间和之后的选定时间间隔；以及苏醒前获取血气值。DES显著（P < 0.05）增加心率（HR），降低平均动脉压（MAP）和心输出量（CO）。PA压力和肺血管阻力（PVR）增加；全身血管阻力（SVR）未改变。在OLV和使用DES期间，HR和CO增加，MAP和SVR降低。还观察到PaO2（OLV开始后5分钟从411±88降至271±131 mmHg；平均值±标准差）和氧含量（CaO2）降低，分流分数（Qs/Qt；OLV开始后5分钟从0.25±0.12增至0.40±0.19）增加。与DES的结果相反，ISO增加HR和PA压力，但不改变MAP、CO和PVR。在使用ISO的情况下，OLV期间观察到MAP和SVR降低，CO和PA压力增加。与使用DES期间的结果相似，OLV和使用ISO期间PaO2和CaO2降低，Qs/Qt增加。我们得出结论，在开胸手术患者OLV期间，DES和ISO对全身和肺血流动力学及动脉氧合产生非常相似的改变。
在肺手术患者单肺通气前、期间及之后，地氟烷和异氟烷产生相似的心血管和肺部效应。
