Background: One-lung ventilation (OLV) is generally adopted for thoracic surgery. The systemic application of a high fraction of inspiratory oxygen (F<sub>1</sub>O<sub>2</sub>) and continuous p...Background: One-lung ventilation (OLV) is generally adopted for thoracic surgery. The systemic application of a high fraction of inspiratory oxygen (F<sub>1</sub>O<sub>2</sub>) and continuous positive airway pressure (CPAP) to the non-ventilated lung is useful for preventing arterial oxygen desaturation. The adverse effects of elevated F<sub>1</sub>O<sub>2</sub> include oxidative lung injury, resorption atelectasis and coronary and peripheral vasoconstriction. It is preferable to avoid hyperoxemia in patients with complications such as chronic obstructive pulmonary disease, idiopathic pneumonia, and bleomycin-treated lungs. We aimed to determine whether the application of 60% O<sub>2</sub> CPAP to the non-ventilated lung is sufficient to provide adequate oxygenation with 60% O<sub>2</sub> to the ventilated lung. Methods: A total of 70 patients scheduled to receive elective thoracic surgery requiring OLV were recruited. Left double-lumen tubes were applicable in all surgeries. Patients were randomly allocated to one of two groups, to receive either 60% O<sub>2</sub> CPAP (60% CPAP group, n = 35), or 100% O<sub>2</sub> CPAP (100% CPAP group, n = 35) at a setting of 2 - 3 cmH<sub>2</sub>O, applied to the non-ventilated lung. Arterial blood gas analyses were obtained at the following stages: RA, spontaneous breathing under room air (RA);TLV, during total lung ventilation (TLV) prior to the initiation of OLV;T5, 5 min after the initiation of OLV;T15, 15 min after the initiation of OLV;T30, 30 min after the initiation of OLV. Results: The PaO<sub>2</sub> value in 60% CPAP group vs. 100% CPAP group at each measurement were as follows: RA (mean [standard deviation: SD], 89.7 [8.2] mmHg vs. 85.8 [11.9] mmHg);TLV (277.9 [52.9] mmHg vs. 269.2 [44.0] mmHg);T5 (191.4 [67.9] mmHg vs. 192.3 [66.0] mmHg);T15 (143.2 [67.3] mmHg vs. 154.7 [60.8] mmHg) and T30 (95.6 [32.0] mmHg vs. 112.5 [36.5] mmHg), respectively. Among the five measurement points, T30 was the only time point at which the 100% CPAP group showed a significantly greater PaO<sub>2</sub> value than the 60% CPAP group (p = 0.0495). The SaO<sub>2</sub> at T30 in the 100% CPAP group (97.4 [2.0]%) was also significantly greater than that in the 60% CPAP group (96.3 [2.2]%, p = 0.039). No differences were found between the groups regarding changes to the overall PaO<sub>2</sub> values (p = 0.44) and SaO<sub>2</sub> values (p = 0.23) during the study period. Conclusions: Oxygenation could be safely maintained in relatively healthy patients with 60% O<sub>2</sub> OLV and 60% O<sub>2</sub> CPAP. The application of 60% O<sub>2</sub> CPAP during OLV for patients who are not suited to exposure to high F<sub>1</sub>O<sub>2</sub> may be an alternative form of respiratory management.展开更多
BACKGROUND Superimposed high-frequency jet ventilation(SHFJV)is suitable for respiratory motion reduction and essential for effective lung tumor ablation.Fluid filling of the target lung wing one-lung flooding(OLF)is ...BACKGROUND Superimposed high-frequency jet ventilation(SHFJV)is suitable for respiratory motion reduction and essential for effective lung tumor ablation.Fluid filling of the target lung wing one-lung flooding(OLF)is necessary for therapeutic ultrasound applications.However,whether unilateral SHFJV allows adequate hemodynamics and gas exchange is unclear.AIM To compared SHFJV with pressure-controlled ventilation(PCV)during OLF by assessing hemodynamics and gas exchange in different animal positions.METHODS SHFJV or PCV was used alternatingly to ventilate the non-flooded lungs of the 12 anesthetized pigs during OLF.The animal positions were changed from left lateral position to supine position(SP)to right lateral position(RLP)every 30 min.In each position,ventilation was maintained for 15 min in both modalities.Hemodynamic variables and arterial blood gas levels were repeatedly measured.RESULTS Unilateral SHFJV led to lower carbon dioxide removal than PCV without abnormally elevated carbon dioxide levels.SHFJV slightly decreased oxygenation in SP and RLP compared with PCV;the lowest values of PaO_(2) and PaO_(2)/FiO_(2) ratio were found in SP[13.0;interquartile range(IQR):12.6-5.6 and 32.5(IQR:31.5-38.9)kPa].Conversely,during SHFJV,the shunt fraction was higher in all animal positions(highest in the RLP:0.30).CONCLUSION In porcine model,unilateral SHFJV may provide adequate ventilation in different animal positions during OLF.Lower oxygenation and CO_(2) removal rates compared to PCV did not lead to hypoxia or hypercapnia.SHFJV can be safely used for lung tumor ablation to minimize ventilation-induced lung motion.展开更多
BACKGROUND Patients with ankylosing spondylitis(AS)combined with severe cervical fusion deformity have difficult airways.Awake fiberoptic intubation is the standard treatment for such patients.Alleviating anxiety and ...BACKGROUND Patients with ankylosing spondylitis(AS)combined with severe cervical fusion deformity have difficult airways.Awake fiberoptic intubation is the standard treatment for such patients.Alleviating anxiety and discomfort during intubation while maintaining airway patency and adequate ventilation is a major challenge for anesthesiologists.Bronchial blockers(BBs)have significant advantages over double-lumen tubes in these patients requiring one-lung ventilation.AIM To evaluate effective drugs and their optimal dosage for awake fiberoptic nasotracheal intubation in patients with AS and to assess the pulmonary isolation effect of one-lung ventilation with a BB.METHODS We studied 12 AS patients(11 men and one woman)with lung or esophageal cancer who underwent thoracotomy with a BB.Preoperative airway evaluation found that all patients had a difficult airway.All patients received an intramuscular injection of penehyclidine hydrochloride(0.01 mg/kg)before anesthesia.In the operating room,dexmedetomidine(0.5μg/kg)was infused intravenously for 10 min,with 2%lidocaine for airway surface anesthesia,and a 3%ephedrine cotton swab was used to contract the nasal mucosa vessels.Before tracheal intubation,fentanyl(1μg/kg)and midazolam(0.02 mg/kg)were administered intravenously.Awake fiberoptic nasotracheal intubation was performed in the semi-reclining position.Intravenous anesthesia was administered immediately after successful intubation,and a BB was inserted laterally.The pre-intubation preparation time,intubation time,facial grimace score,airway responsiveness score during the fiberoptic introduction,time of end tracheal catheter entry into the nostril,and lung collapse and surgical field score were measured.Systolic blood pressure(SBP),diastolic blood pressure(DBP),and heart rate(HR)were recorded while entering the operation room(T1),before intubation(T2),immediately after intubation(T3),2 min after intubation(T4),and 10 min after intubation(T5).After surgery,all patients were followed for adverse reactions such as epistaxis,sore throat,hoarseness,and dysphagia.RESULTS All patients had a history of AS(20.4±9.6 years).They had a Willson's score of 5 or above,grade III or IV Mallampati tests,an inter-incisor distance of 2.9±0.3 cm,and a thyromental(T-M)distance of 4.8±0.7 cm.The average pre-intubation preparation time was 20.4±3.4 min,intubation time was 2.6±0.4 min,facial grimace score was 1.7±0.7,airway responsiveness score was 1.1±0.7,and pulmonary collapse and surgical exposure score was 1.2±0.4.The SBP,DBP,and HR at T5 were significantly lower than those at T1-T4(P<0.05).While the values at T1 were not significantly different from those at T2-T4(P>0.05),they were significantly different from those at T5(P<0.05).Seven patients had minor epistaxis during endotracheal intubation,two were followed 24 h after surgery with a mild sore throat,and two had hoarseness without dysphagia.CONCLUSION Patients with AS combined with severe cervical and thoracic kyphosis should be intubated using fiberoptic bronchoscopy under conscious sedation and topical anesthesia.Proper doses of penehyclidine hydrochloride,dexmedetomidine,fentanyl,and midazolam,combined with 2%lidocaine,administered prior to intubation,can provide satisfactory conditions for tracheal intubation while maintaining the comfort and safety of patients.BBs are safe and effective for onelung ventilation in such patients during thoracotomy.展开更多
Background:Post-operative pneumonia(POP)is a common complication of lung cancer surgery,and muscular tissue oxygenation is a root cause of post-operative complications.However,the association between muscular tissue d...Background:Post-operative pneumonia(POP)is a common complication of lung cancer surgery,and muscular tissue oxygenation is a root cause of post-operative complications.However,the association between muscular tissue desaturation and POP in patients receiving lung cancer surgery has not been specifically studied.This study aimed to investigate the potential use of intra-operative muscular tissue desaturation as a predictor of POP in patients undergoing lung cancer surgery.Methods:This cohort study enrolled patients(≥55 years)who had undergone lobectomy with one-lung ventilation.Muscular tissue oxygen saturation(SmtO_(2))was monitored in the forearm(over the brachioradialis muscle)and upper thigh(over the quadriceps)using a tissue oximeter.The minimum SmtO_(2)was the lowest intra-operative measurement at any time point.Muscular tissue desaturation was defined as a minimum baseline SmtO_(2)of<80%for>15 s.The area under or above the threshold was the product of the magnitude and time of desaturation.The primary outcome was the association between intra-operative muscular tissue desaturation and POP within seven post-operative days using multivariable logistic regression.The secondary outcome was the correlation between SmtO_(2)in the forearm and that in the thigh.Results:We enrolled 174 patients.The overall incidence of muscular desaturation(defined as SmtO_(2)<80%in the forearm at baseline)was approximately 47.1%(82/174).The patients with muscular desaturation had a higher incidence of pneumonia than those without desaturation(28.0%[23/82]vs.12.0%[11/92];P=0.008).The multivariable analysis revealed that muscular desaturation was associated with an increased risk of pneumonia(odds ratio:2.995,95%confidence interval:1.080-8.310,P=0.035)after adjusting for age,American Society of Anesthesiologists status,Assess Respiratory Risk in Surgical Patients in Catalonia score,smoking,use of peripheral nerve block,propofol,and study center.Conclusion:Muscular tissue desaturation,defined as a baseline SmtO_(2)<80%in the forearm,may be associated with an increased risk of POP.Trial registration:No.ChiCTR-ROC-17012627.展开更多
文摘Background: One-lung ventilation (OLV) is generally adopted for thoracic surgery. The systemic application of a high fraction of inspiratory oxygen (F<sub>1</sub>O<sub>2</sub>) and continuous positive airway pressure (CPAP) to the non-ventilated lung is useful for preventing arterial oxygen desaturation. The adverse effects of elevated F<sub>1</sub>O<sub>2</sub> include oxidative lung injury, resorption atelectasis and coronary and peripheral vasoconstriction. It is preferable to avoid hyperoxemia in patients with complications such as chronic obstructive pulmonary disease, idiopathic pneumonia, and bleomycin-treated lungs. We aimed to determine whether the application of 60% O<sub>2</sub> CPAP to the non-ventilated lung is sufficient to provide adequate oxygenation with 60% O<sub>2</sub> to the ventilated lung. Methods: A total of 70 patients scheduled to receive elective thoracic surgery requiring OLV were recruited. Left double-lumen tubes were applicable in all surgeries. Patients were randomly allocated to one of two groups, to receive either 60% O<sub>2</sub> CPAP (60% CPAP group, n = 35), or 100% O<sub>2</sub> CPAP (100% CPAP group, n = 35) at a setting of 2 - 3 cmH<sub>2</sub>O, applied to the non-ventilated lung. Arterial blood gas analyses were obtained at the following stages: RA, spontaneous breathing under room air (RA);TLV, during total lung ventilation (TLV) prior to the initiation of OLV;T5, 5 min after the initiation of OLV;T15, 15 min after the initiation of OLV;T30, 30 min after the initiation of OLV. Results: The PaO<sub>2</sub> value in 60% CPAP group vs. 100% CPAP group at each measurement were as follows: RA (mean [standard deviation: SD], 89.7 [8.2] mmHg vs. 85.8 [11.9] mmHg);TLV (277.9 [52.9] mmHg vs. 269.2 [44.0] mmHg);T5 (191.4 [67.9] mmHg vs. 192.3 [66.0] mmHg);T15 (143.2 [67.3] mmHg vs. 154.7 [60.8] mmHg) and T30 (95.6 [32.0] mmHg vs. 112.5 [36.5] mmHg), respectively. Among the five measurement points, T30 was the only time point at which the 100% CPAP group showed a significantly greater PaO<sub>2</sub> value than the 60% CPAP group (p = 0.0495). The SaO<sub>2</sub> at T30 in the 100% CPAP group (97.4 [2.0]%) was also significantly greater than that in the 60% CPAP group (96.3 [2.2]%, p = 0.039). No differences were found between the groups regarding changes to the overall PaO<sub>2</sub> values (p = 0.44) and SaO<sub>2</sub> values (p = 0.23) during the study period. Conclusions: Oxygenation could be safely maintained in relatively healthy patients with 60% O<sub>2</sub> OLV and 60% O<sub>2</sub> CPAP. The application of 60% O<sub>2</sub> CPAP during OLV for patients who are not suited to exposure to high F<sub>1</sub>O<sub>2</sub> may be an alternative form of respiratory management.
文摘BACKGROUND Superimposed high-frequency jet ventilation(SHFJV)is suitable for respiratory motion reduction and essential for effective lung tumor ablation.Fluid filling of the target lung wing one-lung flooding(OLF)is necessary for therapeutic ultrasound applications.However,whether unilateral SHFJV allows adequate hemodynamics and gas exchange is unclear.AIM To compared SHFJV with pressure-controlled ventilation(PCV)during OLF by assessing hemodynamics and gas exchange in different animal positions.METHODS SHFJV or PCV was used alternatingly to ventilate the non-flooded lungs of the 12 anesthetized pigs during OLF.The animal positions were changed from left lateral position to supine position(SP)to right lateral position(RLP)every 30 min.In each position,ventilation was maintained for 15 min in both modalities.Hemodynamic variables and arterial blood gas levels were repeatedly measured.RESULTS Unilateral SHFJV led to lower carbon dioxide removal than PCV without abnormally elevated carbon dioxide levels.SHFJV slightly decreased oxygenation in SP and RLP compared with PCV;the lowest values of PaO_(2) and PaO_(2)/FiO_(2) ratio were found in SP[13.0;interquartile range(IQR):12.6-5.6 and 32.5(IQR:31.5-38.9)kPa].Conversely,during SHFJV,the shunt fraction was higher in all animal positions(highest in the RLP:0.30).CONCLUSION In porcine model,unilateral SHFJV may provide adequate ventilation in different animal positions during OLF.Lower oxygenation and CO_(2) removal rates compared to PCV did not lead to hypoxia or hypercapnia.SHFJV can be safely used for lung tumor ablation to minimize ventilation-induced lung motion.
基金Supported by National Natural Science Foundation of China,No.81672250Special Fund for Resident Training in Qilu Hospital of Shandong University,No.ZPZX2019A08.
文摘BACKGROUND Patients with ankylosing spondylitis(AS)combined with severe cervical fusion deformity have difficult airways.Awake fiberoptic intubation is the standard treatment for such patients.Alleviating anxiety and discomfort during intubation while maintaining airway patency and adequate ventilation is a major challenge for anesthesiologists.Bronchial blockers(BBs)have significant advantages over double-lumen tubes in these patients requiring one-lung ventilation.AIM To evaluate effective drugs and their optimal dosage for awake fiberoptic nasotracheal intubation in patients with AS and to assess the pulmonary isolation effect of one-lung ventilation with a BB.METHODS We studied 12 AS patients(11 men and one woman)with lung or esophageal cancer who underwent thoracotomy with a BB.Preoperative airway evaluation found that all patients had a difficult airway.All patients received an intramuscular injection of penehyclidine hydrochloride(0.01 mg/kg)before anesthesia.In the operating room,dexmedetomidine(0.5μg/kg)was infused intravenously for 10 min,with 2%lidocaine for airway surface anesthesia,and a 3%ephedrine cotton swab was used to contract the nasal mucosa vessels.Before tracheal intubation,fentanyl(1μg/kg)and midazolam(0.02 mg/kg)were administered intravenously.Awake fiberoptic nasotracheal intubation was performed in the semi-reclining position.Intravenous anesthesia was administered immediately after successful intubation,and a BB was inserted laterally.The pre-intubation preparation time,intubation time,facial grimace score,airway responsiveness score during the fiberoptic introduction,time of end tracheal catheter entry into the nostril,and lung collapse and surgical field score were measured.Systolic blood pressure(SBP),diastolic blood pressure(DBP),and heart rate(HR)were recorded while entering the operation room(T1),before intubation(T2),immediately after intubation(T3),2 min after intubation(T4),and 10 min after intubation(T5).After surgery,all patients were followed for adverse reactions such as epistaxis,sore throat,hoarseness,and dysphagia.RESULTS All patients had a history of AS(20.4±9.6 years).They had a Willson's score of 5 or above,grade III or IV Mallampati tests,an inter-incisor distance of 2.9±0.3 cm,and a thyromental(T-M)distance of 4.8±0.7 cm.The average pre-intubation preparation time was 20.4±3.4 min,intubation time was 2.6±0.4 min,facial grimace score was 1.7±0.7,airway responsiveness score was 1.1±0.7,and pulmonary collapse and surgical exposure score was 1.2±0.4.The SBP,DBP,and HR at T5 were significantly lower than those at T1-T4(P<0.05).While the values at T1 were not significantly different from those at T2-T4(P>0.05),they were significantly different from those at T5(P<0.05).Seven patients had minor epistaxis during endotracheal intubation,two were followed 24 h after surgery with a mild sore throat,and two had hoarseness without dysphagia.CONCLUSION Patients with AS combined with severe cervical and thoracic kyphosis should be intubated using fiberoptic bronchoscopy under conscious sedation and topical anesthesia.Proper doses of penehyclidine hydrochloride,dexmedetomidine,fentanyl,and midazolam,combined with 2%lidocaine,administered prior to intubation,can provide satisfactory conditions for tracheal intubation while maintaining the comfort and safety of patients.BBs are safe and effective for onelung ventilation in such patients during thoracotomy.
基金National Key R&D Program of China(No.2018YFC2001800)Project of Health Commission of Hebei Province(No.20190709)
文摘Background:Post-operative pneumonia(POP)is a common complication of lung cancer surgery,and muscular tissue oxygenation is a root cause of post-operative complications.However,the association between muscular tissue desaturation and POP in patients receiving lung cancer surgery has not been specifically studied.This study aimed to investigate the potential use of intra-operative muscular tissue desaturation as a predictor of POP in patients undergoing lung cancer surgery.Methods:This cohort study enrolled patients(≥55 years)who had undergone lobectomy with one-lung ventilation.Muscular tissue oxygen saturation(SmtO_(2))was monitored in the forearm(over the brachioradialis muscle)and upper thigh(over the quadriceps)using a tissue oximeter.The minimum SmtO_(2)was the lowest intra-operative measurement at any time point.Muscular tissue desaturation was defined as a minimum baseline SmtO_(2)of<80%for>15 s.The area under or above the threshold was the product of the magnitude and time of desaturation.The primary outcome was the association between intra-operative muscular tissue desaturation and POP within seven post-operative days using multivariable logistic regression.The secondary outcome was the correlation between SmtO_(2)in the forearm and that in the thigh.Results:We enrolled 174 patients.The overall incidence of muscular desaturation(defined as SmtO_(2)<80%in the forearm at baseline)was approximately 47.1%(82/174).The patients with muscular desaturation had a higher incidence of pneumonia than those without desaturation(28.0%[23/82]vs.12.0%[11/92];P=0.008).The multivariable analysis revealed that muscular desaturation was associated with an increased risk of pneumonia(odds ratio:2.995,95%confidence interval:1.080-8.310,P=0.035)after adjusting for age,American Society of Anesthesiologists status,Assess Respiratory Risk in Surgical Patients in Catalonia score,smoking,use of peripheral nerve block,propofol,and study center.Conclusion:Muscular tissue desaturation,defined as a baseline SmtO_(2)<80%in the forearm,may be associated with an increased risk of POP.Trial registration:No.ChiCTR-ROC-17012627.
