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CARDIOVASCULAR ANESTHESIA

The Effects of Intravenous Almitrine on Oxygenation and Hemodynamics During One-Lung Ventilation

Department of Anesthesiology, Hôpital Foch, Suresnes, France

Address correspondence and reprint requests to Dr. M. Fischler, Service d’Anesthésie, Hôpital Foch, 40 rue Worth, Suresnes, 92151, France. Address e-mail to fischler{at}hopital-foch.org

One-lung ventilation (OLV) induces an increase in pulmonary shunt sometimes associated with a decrease in PaO₂ despite ventilation with 100% oxygen. PaO₂ improvement has been reported in one-lung ventilated animals receiving IV almitrine, a pulmonary vasoconstrictor. We evaluated the ability of almitrine to prevent a decrease in PaO₂ during OLV. Patients without pulmonary hypertension undergoing OLV for lung surgery were randomly assigned to receive either placebo (Group P, n = 8) or almitrine infusion at a rate of 8 µg · kg^-1 · min^-1 (Group A, n = 8) from the start of OLV. Gasometric and hemodynamic values were recorded with the patient in the lateral decubitus position during two-lung ventilation and at 10-min intervals during OLV over a 30-min period (OLV-10, OLV-20, OLV-30). Compared with the values found during two-lung ventilation (434 ± 22 mm Hg in Group P and 426 ± 23 mm Hg in Group A), PaO₂ decreased at OLV-10 (305 ± 46 mm Hg), OLV-20 (203 ± 20 mm Hg), and OLV-30 (178 ± 18 mm Hg) in Group P (P < 0.05) and at OLV-20 (354 ± 25 mm Hg) and OLV-30 (325 ± 17 mm Hg) in Group A (P < 0.05). PaO₂ values differed between the groups at OLV-20 and OLV-30 (P < 0.05). Pulmonary artery pressure and cardiac output did not change. In conclusion, 8 µg · kg^-1 · min^-1 IV almitrine prevents and limits the OLV-induced decrease in PaO₂ without causing any hemodynamic modification.

IMPLICATIONS: Eight µg · kg^-1 · min^-1 IV almitrine limits one-lung ventilation-induced decrease in PaO₂ without causing any hemodynamic modification in patients without pulmonary hypertension.

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