Authors: Iwata, M.; Inoue, S.; Kawaguchi, M.; Takahama, M.; Tojo, T.; Taniguchi, S.; Furuya, H.
Keywords: one-lung ventilation; sevoflurane; propofol; lung surgery; jugular bulb venous oxygen saturation
Abstract (English): Objective: During one-lung ventilation (OLV), systemic oxygenation can be compromised. In such a scenario, if anesthetic techniques were used that adversely affected cerebral oxygen balance, the risk for impaired cerebral oxygen balance may be increased. In this study, jugular bulb venous oxygen saturation (SjO2) during OLV under sevoflurane- or propofol-based anesthesia for lung surgery was investigated. Design: Prospective clinical study. Setting: University hospital. Participants: Fifty-two adult patients scheduled for elective thoracic procedures in the lateral position. Interventions: Patients were randomly allocated to either the sevoflurane or propofol group (n = 26). General anesthesia was maintained with sevoflurane or propofol combined with epidural anesthesia. Measurements and Main Results: Arterial and jugular bulb blood samples were measured before OLV, 15 minutes after OLV, 30 minutes after OLV, and 15 minutes after the termination of OLV. SjO2 values in both sevoflurane and propofol groups significantly declined during OLV (p < 0.05). SjO2 values in the sevoflurane group were higher than in the propofol group, although SaO2 values were similar (p < 0.05). Regarding the incidence of SjO2 <50% (cerebral oxygen desaturation), there were significant differences between the sevoflurane group and the propofol group during both normally ventilated conditions (0% v 7.7%, p < 0.05, relative risk [RR]: not applicable) and OLV (1.9% v 26.9%, p < 0.05, RR = 14; 95% confidence interval [CI] 1.91-103). Significant increase in the incidence of SjO2 <50% during OLV was also observed only in the propofol group (from 7.7% to 26.9%, p < 0.05, RR = 3.5; 95% CI 1.29-12.4). Conclusion: Cerebral oxygen desaturation was more frequently detected during OLV under propofol- versus sevoflurane-based anesthesia. Cerebral oxygen balance during OLV for lung surgery was less impaired under sevoflurane-based anesthesia compared with propofol; however, the clinical outcome or implications for cognitive function need to be determined.

Authors: Al-Rawi, Omar Y. FRCA *; Pennefather, Stephen H. MRCP, FRCA *; Page, Richard D. FRCS +; Dave, Ishani FRCA *; Russell, Glen N. FRCA *

Institution From the Departments of *Anaesthesia and +Thoracic Surgery, Cardiothoracic Centre, Liverpool, United Kingdom.

Title The Effect of Thoracic Epidural Bupivacaine and an Intravenous Adrenaline Infusion on Gastric Tube Blood Flow During Esophagectomy.[Report]

Source Anesthesia & Analgesia. 106(3):884-887, March 2008.

Abstract BACKGROUND: Gastric tube necrosis is a major cause of anastomotic leak after esophagectomy. A correlation has been shown between reduced flux at the anastomotic end of the gastric tube and anastomotic leaks.

METHODS: We prospectively studied the effect of intraoperative thoracic epidural bupivacaine and subsequent adrenaline infusion on hemodynamics and flux in the gastric tube.

RESULTS: Administering the epidural bolus significantly decreased flux at the anastomotic end of the gastric tube (P < 0.01). Gastric flux was returned to baseline by an adrenaline infusion. CONCLUSIONS: The administration of a thoracic epidural bolus may decrease flux at the anastomotic end of the gastric tube.