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Journal of Minimal Access Surgery
Medknow Publications
ISSN: 0972-9941
EISSN: 0972-9941
Vol. 7, No. 4, 2011, pp. 227-231
Bioline Code: ma11053
Full paper language: English
Document type: Research Article
Document available free of charge

Journal of Minimal Access Surgery, Vol. 7, No. 4, 2011, pp. 227-231

 en Effects of dexmedetomidine on oxygenation during one-lung ventilation for thoracic surgery in adults
Kernan, Scott; Rehman, Saif; Meyer, Thomas; Bourbeau, Joan; Caron, Norm & Tobias, Joseph D.

Abstract

Study Objective : To evaluate the effects of dexmedetomidine on hypoxic pulmonary vasoconstriction (HPV) and oxygenation during one-lung ventilation (OLV) in adults undergoing thoracic surgery.
Design : Prospective, randomized, double-blinded trial. Setting : Tertiary care, University-based hospital.
Patients : Nineteen adult patients undergoing thoracic surgery requiring OLV.
Interventions : During inhalational anesthesia with desflurane, patients were randomized to receive either dexmedetomidine (bolus dose of 0.3 μg/kg followed by an infusion of 0.3 μg/kg/hr) or saline placebo.
Measurements : Three arterial blood gas samples (ABG) were obtained to evaluate the effects of dexmedetomidine on oxygenation. Secondary outcomes included differences in hemodynamic parameters (heart rate and mean arterial pressure), end-tidal desflurane concentration required to maintain the bispectral index (BIS) at 40-60, supplemental fentanyl to maintain hemodynamic stability, and phenylephrine to keep the mean arterial pressure (MAP) within 10% of baseline values.
Main Results : Oxygenation during OLV did not change following the administration of dexmedetomidine (PaO2/FiO2 ratio of 188 ± 115 in dexmedetomidine patients versus 135 ± 70 mmHg in placebo patients). There were no differences in hemodynamic variables or depth of anaesthesia between the two groups. With the administration of dexmedetomidine, there was a decrease in the expired concentration of desflurane required to maintain the BIS at 40-60 when compared with the control group (4.5 ± 0.8% versus 5.1 ± 0.8%). In patients receiving dexmedetomidine, fentanyl requirements were decreased when compared to placebo (2.7 μg/kg/patient versus 3.1 μg/kg/patient). However, more patients receiving dexmedetomidine required phenylephrine to maintain hemodynamic stability (6 of 9 patients versus 3 of 10 patients) and the total dose of phenylephrine was greater in patients receiving dexmedetomidine when compared with placebo 10.3 μg/kg/patient versus 1.1 μg/kg/patient).
Conclusion : Dexmedetomidine does not adversely affect oxygenation during OLV in adults undergoing thoracic surgical procedures. The improvement in oxygenation in the dexmedetomidine patients may be related to a decrease in the requirements for inhalational anaesthetic agents thereby limiting its effects on HPV.

Keywords
Dexmedetomidine, hypoxic pulmonary vasoconstriction, one-lung ventilation, thoracoscopy, thoracotomy

 
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