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CARDIOVASCULAR ANESTHESIA

The Effects of Acute Isovolemic Hemodilution on Oxygenation During One-Lung Ventilation

Laszlo L. Szegedi, MD^*, Philippe Van der Linden, MD, PhD, Anne Ducart, MD, Pieter Cosaert, MD^*, Jan Poelaert, MD, PhD, Frank Vermassen, MD, PhD^||, Eric P. Mortier, MD, DSc^*, and Alain A. d’Hollander, MD, PhD^¶

*Department of Anesthesiology, Gent University Hospital, Gent, Belgium; Department of Anesthesiology, Brugmann University Hospital, Brussels, Belgium; Department of Anesthesiology, Erasme University Hospital, Brussels, Belgium; Department of Cardiac Anesthesia and Intensive Care, Gent University Hospital, Gent, Belgium; ||Department of Thoracic and Vascular Surgery, Gent University Hospital, Gent, Belgium; and ¶Department of Anesthesiology, Geneva University Hospital, Geneva, Switzerland

Address correspondence and reprint requests to Laszlo L. Szegedi, MD, Department of Anesthesiology 2K12, Gent University Hospital, De Pintelaan, 185, 9000 Gent, Belgium. Address e-mail to laszlo.szegedi{at}ugent.be

Data on the effects of isovolemic hemodilution (IH) on oxygenation during one-lung ventilation (OLV) are lacking. We studied 47 patients with hemoglobin >14 g/dL who were scheduled for lung surgery (17 with normal lung function [group NL], 17 with chronic obstructive pulmonary disease [COPD] [group COPD], and 13 with COPD as control for time/anesthesia effects [group CTRL]). Anesthesia was standardized. The tracheas were intubated with a double-lumen tube. Ventilatory settings and fraction of inspired oxygen remained constant. The study was performed with patients in the supine position before surgery. OLV was initiated for 15 min. Two-lung ventilation was reinstituted, and IH was performed (500 mL); an identical volume of hydroxyethyl starch was administered. Subsequently, OLV was again performed for 15 min. In group CTRL, the same sequences of OLV were performed without IH. At the end of each period of OLV, pulmonary mechanics and blood gases were recorded. Data were analyzed by analysis of variance (mean ± SD). In group NL and group CTRL, the arterial oxygen partial pressure remained constant, whereas it decreased in group COPD from 119 ± 21 mm Hg before IH to 86 ± 16 mm Hg after IH (P < 0.01). Mild IH impairs gas exchange during OLV in COPD patients, but not in patients with normal lung function.

IMPLICATIONS: This clinical study suggests that hemodilution impairs gas exchange during one-lung ventilation in patients with pulmonary hyperinflation and chronic obstructive lung disease, but not in patients with normal lungs; the reasons for this finding are not clear.

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				A. I. Levin and J. F. Coetzee Arterial Oxygenation During One-Lung Anesthesia Anesth. Analg., January 1, 2005; 100(1): 12 - 14. [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999