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CARDIOVASCULAR ANESTHESIA

The Effects of Increasing Concentrations of Isoflurane and Desflurane on Pulmonary Perfusion and Systemic Oxygenation During One-Lung Ventilation in Pigs

Konrad Schwarzkopf, MD, Torsten Schreiber, MD, Reinhard Bauer, MD^*, Harald Schubert, VD, Niels-Peter Preussler, MD, Elke Gaser, MD, Uwe Klein, MD, and Waheedullah Karzai, MD

Department of Anesthesiology and Intensive Care Medicine, *Department of Pathophysiology, and Institute for Experimental Animals, University of Jena, Germany

Address correspondence and reprint requests to Waheedullah Karzai, MD, Department of Anesthesia and Intensive Care, Zentralklinik Bad Berka, Robert-Koch-Allee 9, 99437 Bad Berka, Germany. Address e-mail to W.Karzai.ana{at}Zentralklinik-Bad-Berka.de

During one-lung ventilation (OLV), hypoxic pulmonary vasoconstriction (HPV) reduces venous admixture and attenuates the decrease in arterial oxygen tension by diverting blood from the nonventilated lung to the ventilated lung. In vitro, desflurane and isoflurane depress HPV in a dose-dependent manner. Accordingly, we studied the effects of increasing concentrations of desflurane and isoflurane on pulmonary perfusion, shunt fraction, and PaO₂ during OLV in vivo. Fourteen pigs (30–42 kg) were anesthetized, tracheally intubated, and mechanically ventilated. After placement of femoral arterial and thermodilution pulmonary artery catheters, a left-sided double-lumen tube (DLT) was placed via tracheotomy. After DLT placement, FIO₂ was adjusted at 0.8 and anesthesia was continued in random order with 3 concentrations (0.5, 1.0, and 1.5 minimal alveolar concentrations) of either desflurane or isoflurane. Differential lung perfusion was measured with colored microspheres. All measurements were made after stabilization at each concentration. Whereas mixed venous PO₂, mean arterial pressure, cardiac output, nonventilated lung perfusion, and shunt fraction decreased in a dose-dependent manner, PaO₂ remained unchanged with increasing concentrations of desflurane and isoflurane during OLV. In conclusion, increasing concentration of desflurane and isoflurane did not impair oxygenation during OLV in pigs.

IMPLICATIONS: In an animal model of one-lung ventilation, increasing concentrations of desflurane and isoflurane dose-dependently decreased shunt fraction and perfusion of the nonventilated lung and did not impair oxygenation. The decreases in shunt fraction are likely the result of anesthetic-induced marked decreases in cardiac output and mixed venous saturation.

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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