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The effect of epidural dexmedetomidine on oxygenation and shunt fraction in patients undergoing thoracotomy and one lung ventilation: A randomized controlled study
BACKGROUND AND AIMS: Role of epidural dexmedetomidine in providing analgesia is well documented, but its effect on oxygenation and shunt fraction is not well established. We studied the hypothesis that epidural dexmedetomidine may improve oxygenation and shunt fraction during one-lung ventilation (O...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Medknow Publications & Media Pvt Ltd
2016
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5187609/ https://www.ncbi.nlm.nih.gov/pubmed/28096575 http://dx.doi.org/10.4103/0970-9185.194771 |
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author | Kar, Prachi Durga, Padmaja Gopinath, Ramachandran |
author_facet | Kar, Prachi Durga, Padmaja Gopinath, Ramachandran |
author_sort | Kar, Prachi |
collection | PubMed |
description | BACKGROUND AND AIMS: Role of epidural dexmedetomidine in providing analgesia is well documented, but its effect on oxygenation and shunt fraction is not well established. We studied the hypothesis that epidural dexmedetomidine may improve oxygenation and shunt fraction during one-lung ventilation (OLV). MATERIAL AND METHODS: After taking Institutional Ethics Committee approval, sixty patients undergoing thoracotomy and OLV were randomized to receive epidural ropivacaine with saline (RS group) or epidural ropivacaine with dexmedetomidine (RD group). Group RS received 7 ml of ropivacaine 0.5% with 1.5 ml normal saline (NS) bolus while RD group received 7 ml of 0.5% ropivacaine with 1 mcg/kg dexmedetomidine reconstituted in 1.5 ml NS. This was followed by infusion of 5 ml/h of 0.5% ropivacaine in RS group and 5 ml/h of 0.5% ropivacaine containing 0.2 mcg/kg of dexmedetomidine in RD group. Arterial and central venous blood gas parameters were obtained 15 minutes after intubation during two lung ventilation (TLV15), 15 and 45 min after OLV (OLV15, OLV45) and 15 minutes after reinstitution of two lung ventilation (ReTLV). RESULTS: RD group had better oxygenation (254.2 ± 72.3 mmHg, 240.60 ± 59.26 mmHg) as compared to RS group (215.2 ± 64.3 mmHg, 190.7 ± 61.48 mmHg) at OLV15 (P – 0.04) and OLV45 (P – 0.004) respectively. Shunt fraction in RD group was (30.31 ± 7.89%, 33.76 ± 8.89%) and (35.14 ± 7.58%, 39.57 ± 13.03%) in RS group at OLV15 and OLV45, respectively. The increase in the shunt fraction from TLV15 was significantly greater in RS group than RD group both at OLV15 (P – 0.03) and OLV45 (P – 0.03). The sevoflurane and fentanyl requirement was lower in RD group. CONCLUSION: Epidural dexmedetomidine improves oxygenation and reduces shunt fraction during OLV, in patients undergoing thoracotomy. It also reduces intraoperative anesthetic and analgesic requirement. |
format | Online Article Text |
id | pubmed-5187609 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Medknow Publications & Media Pvt Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-51876092017-01-17 The effect of epidural dexmedetomidine on oxygenation and shunt fraction in patients undergoing thoracotomy and one lung ventilation: A randomized controlled study Kar, Prachi Durga, Padmaja Gopinath, Ramachandran J Anaesthesiol Clin Pharmacol Original Article BACKGROUND AND AIMS: Role of epidural dexmedetomidine in providing analgesia is well documented, but its effect on oxygenation and shunt fraction is not well established. We studied the hypothesis that epidural dexmedetomidine may improve oxygenation and shunt fraction during one-lung ventilation (OLV). MATERIAL AND METHODS: After taking Institutional Ethics Committee approval, sixty patients undergoing thoracotomy and OLV were randomized to receive epidural ropivacaine with saline (RS group) or epidural ropivacaine with dexmedetomidine (RD group). Group RS received 7 ml of ropivacaine 0.5% with 1.5 ml normal saline (NS) bolus while RD group received 7 ml of 0.5% ropivacaine with 1 mcg/kg dexmedetomidine reconstituted in 1.5 ml NS. This was followed by infusion of 5 ml/h of 0.5% ropivacaine in RS group and 5 ml/h of 0.5% ropivacaine containing 0.2 mcg/kg of dexmedetomidine in RD group. Arterial and central venous blood gas parameters were obtained 15 minutes after intubation during two lung ventilation (TLV15), 15 and 45 min after OLV (OLV15, OLV45) and 15 minutes after reinstitution of two lung ventilation (ReTLV). RESULTS: RD group had better oxygenation (254.2 ± 72.3 mmHg, 240.60 ± 59.26 mmHg) as compared to RS group (215.2 ± 64.3 mmHg, 190.7 ± 61.48 mmHg) at OLV15 (P – 0.04) and OLV45 (P – 0.004) respectively. Shunt fraction in RD group was (30.31 ± 7.89%, 33.76 ± 8.89%) and (35.14 ± 7.58%, 39.57 ± 13.03%) in RS group at OLV15 and OLV45, respectively. The increase in the shunt fraction from TLV15 was significantly greater in RS group than RD group both at OLV15 (P – 0.03) and OLV45 (P – 0.03). The sevoflurane and fentanyl requirement was lower in RD group. CONCLUSION: Epidural dexmedetomidine improves oxygenation and reduces shunt fraction during OLV, in patients undergoing thoracotomy. It also reduces intraoperative anesthetic and analgesic requirement. Medknow Publications & Media Pvt Ltd 2016 /pmc/articles/PMC5187609/ /pubmed/28096575 http://dx.doi.org/10.4103/0970-9185.194771 Text en Copyright: © Journal of Anaesthesiology Clinical Pharmacology http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. |
spellingShingle | Original Article Kar, Prachi Durga, Padmaja Gopinath, Ramachandran The effect of epidural dexmedetomidine on oxygenation and shunt fraction in patients undergoing thoracotomy and one lung ventilation: A randomized controlled study |
title | The effect of epidural dexmedetomidine on oxygenation and shunt fraction in patients undergoing thoracotomy and one lung ventilation: A randomized controlled study |
title_full | The effect of epidural dexmedetomidine on oxygenation and shunt fraction in patients undergoing thoracotomy and one lung ventilation: A randomized controlled study |
title_fullStr | The effect of epidural dexmedetomidine on oxygenation and shunt fraction in patients undergoing thoracotomy and one lung ventilation: A randomized controlled study |
title_full_unstemmed | The effect of epidural dexmedetomidine on oxygenation and shunt fraction in patients undergoing thoracotomy and one lung ventilation: A randomized controlled study |
title_short | The effect of epidural dexmedetomidine on oxygenation and shunt fraction in patients undergoing thoracotomy and one lung ventilation: A randomized controlled study |
title_sort | effect of epidural dexmedetomidine on oxygenation and shunt fraction in patients undergoing thoracotomy and one lung ventilation: a randomized controlled study |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5187609/ https://www.ncbi.nlm.nih.gov/pubmed/28096575 http://dx.doi.org/10.4103/0970-9185.194771 |
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