Yuxian Wang BS , Yilin Wei BS , Guannan Chen M.D., Ph.D , Zhiyao Wang M.D., Ph.D , Yu Fan MS , Jie Wang MS , Yuanjun Yang BS , Di Zhou M.D., Ph.D , Ming Zhong M.D., Ph.D
{"title":"单肺通气时胸腔硬膜外阻滞对通气-灌注匹配的影响：一项探索性研究。","authors":"Yuxian Wang BS , Yilin Wei BS , Guannan Chen M.D., Ph.D , Zhiyao Wang M.D., Ph.D , Yu Fan MS , Jie Wang MS , Yuanjun Yang BS , Di Zhou M.D., Ph.D , Ming Zhong M.D., Ph.D","doi":"10.1016/j.jclinane.2024.111678","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>Electrical impedance tomography (EIT) enables continuous image acquisition, facilitating real-time measurements of ventilation and perfusion at the clinical bedside. Experimental and clinical studies on controversial effects of thoracic epidural blockade (TEB) with local anesthetics on ventilation-perfusion(V/Q) matching and hypoxia during one lung ventilation (OLV) are rare. The aim of this study was to use EIT to investigate the effects of TEB combined with general anesthesia on pulmonary perfusion distribution and V/Q matching during one-lung ventilation.</div></div><div><h3>Design</h3><div>Single-centered, prospective, unblinded, randomized, parallel-group clinical trial.</div></div><div><h3>Setting</h3><div>Surgical suite of a university-affiliated teaching hospital.</div></div><div><h3>Patients</h3><div>Thirty patients prepared for thoracic surgery were randomly assigned to either the control group or the TEB group, which received a combination of thoracic epidural blockade and general anesthesia.</div></div><div><h3>Measurements</h3><div>EIT measurements and blood gas analysis were conducted in the lateral position during two-lung ventilation(T<sub>0</sub>), 15 min after OLV(T<sub>1</sub>), and 15 min after administration of 0.25 % ropivacaine or 0.9 % saline via epidural delivery during OLV(T<sub>2</sub>). Hemodynamic and respiratory parameters were recorded, and Dead Space%, Shunt%, and V/Q Match% were calculated based on blood gas analysis and EIT images.</div></div><div><h3>Results</h3><div>Mean arterial pressure (<em>p</em> < 0.05) significantly decreased 15 min after TEB, while there were no significant changes in heart rate among the 30 patients (<em>p</em> = 0.547). OLV resulted in a significant decrease in arterial oxygen partial pressure/inspired oxygen fraction (PaO<sub>2</sub>/FiO<sub>2</sub>) from T<sub>0</sub> to T<sub>1</sub> in both groups. The PaO<sub>2</sub>/FiO<sub>2</sub> in the TEB group was significantly lower after epidural administration of the local anesthetic (<em>p</em> < 0.05). Shunt- ABG (%) was significantly higher in the TEB group compared to the control group at T<sub>2</sub> (<em>p</em> < 0.05). TEB increased non-ventilated perfusion distribution(p < 0.05), and Shunt-EIT % (p < 0.05) and reduced Matched Region % (p < 0.05), while Dead Space-EIT % remained (<em>p</em> = 0.499).</div></div><div><h3>Conclusions</h3><div>Based on the contrast-enhanced EIT evaluation of pulmonary perfusion and ventilation, TEB appears to induce a V/Q mismatch in patients undergoing OLV in the lateral position for thoracic surgery.</div><div>Trial registration: <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>, <span><span>NCT04730089</span><svg><path></path></svg></span>. Registration on January 25th, 2021.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111678"},"PeriodicalIF":5.0000,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The effects of thoracic epidural blockade on ventilation-perfusion matching during one-lung ventilation: An exploratory study\",\"authors\":\"Yuxian Wang BS , Yilin Wei BS , Guannan Chen M.D., Ph.D , Zhiyao Wang M.D., Ph.D , Yu Fan MS , Jie Wang MS , Yuanjun Yang BS , Di Zhou M.D., Ph.D , Ming Zhong M.D., Ph.D\",\"doi\":\"10.1016/j.jclinane.2024.111678\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><div>Electrical impedance tomography (EIT) enables continuous image acquisition, facilitating real-time measurements of ventilation and perfusion at the clinical bedside. Experimental and clinical studies on controversial effects of thoracic epidural blockade (TEB) with local anesthetics on ventilation-perfusion(V/Q) matching and hypoxia during one lung ventilation (OLV) are rare. The aim of this study was to use EIT to investigate the effects of TEB combined with general anesthesia on pulmonary perfusion distribution and V/Q matching during one-lung ventilation.</div></div><div><h3>Design</h3><div>Single-centered, prospective, unblinded, randomized, parallel-group clinical trial.</div></div><div><h3>Setting</h3><div>Surgical suite of a university-affiliated teaching hospital.</div></div><div><h3>Patients</h3><div>Thirty patients prepared for thoracic surgery were randomly assigned to either the control group or the TEB group, which received a combination of thoracic epidural blockade and general anesthesia.</div></div><div><h3>Measurements</h3><div>EIT measurements and blood gas analysis were conducted in the lateral position during two-lung ventilation(T<sub>0</sub>), 15 min after OLV(T<sub>1</sub>), and 15 min after administration of 0.25 % ropivacaine or 0.9 % saline via epidural delivery during OLV(T<sub>2</sub>). Hemodynamic and respiratory parameters were recorded, and Dead Space%, Shunt%, and V/Q Match% were calculated based on blood gas analysis and EIT images.</div></div><div><h3>Results</h3><div>Mean arterial pressure (<em>p</em> < 0.05) significantly decreased 15 min after TEB, while there were no significant changes in heart rate among the 30 patients (<em>p</em> = 0.547). OLV resulted in a significant decrease in arterial oxygen partial pressure/inspired oxygen fraction (PaO<sub>2</sub>/FiO<sub>2</sub>) from T<sub>0</sub> to T<sub>1</sub> in both groups. The PaO<sub>2</sub>/FiO<sub>2</sub> in the TEB group was significantly lower after epidural administration of the local anesthetic (<em>p</em> < 0.05). Shunt- ABG (%) was significantly higher in the TEB group compared to the control group at T<sub>2</sub> (<em>p</em> < 0.05). TEB increased non-ventilated perfusion distribution(p < 0.05), and Shunt-EIT % (p < 0.05) and reduced Matched Region % (p < 0.05), while Dead Space-EIT % remained (<em>p</em> = 0.499).</div></div><div><h3>Conclusions</h3><div>Based on the contrast-enhanced EIT evaluation of pulmonary perfusion and ventilation, TEB appears to induce a V/Q mismatch in patients undergoing OLV in the lateral position for thoracic surgery.</div><div>Trial registration: <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>, <span><span>NCT04730089</span><svg><path></path></svg></span>. Registration on January 25th, 2021.</div></div>\",\"PeriodicalId\":15506,\"journal\":{\"name\":\"Journal of Clinical Anesthesia\",\"volume\":\"99 \",\"pages\":\"Article 111678\"},\"PeriodicalIF\":5.0000,\"publicationDate\":\"2024-11-06\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Clinical Anesthesia\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0952818024003076\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Anesthesia","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0952818024003076","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
The effects of thoracic epidural blockade on ventilation-perfusion matching during one-lung ventilation: An exploratory study
Objective
Electrical impedance tomography (EIT) enables continuous image acquisition, facilitating real-time measurements of ventilation and perfusion at the clinical bedside. Experimental and clinical studies on controversial effects of thoracic epidural blockade (TEB) with local anesthetics on ventilation-perfusion(V/Q) matching and hypoxia during one lung ventilation (OLV) are rare. The aim of this study was to use EIT to investigate the effects of TEB combined with general anesthesia on pulmonary perfusion distribution and V/Q matching during one-lung ventilation.
Surgical suite of a university-affiliated teaching hospital.
Patients
Thirty patients prepared for thoracic surgery were randomly assigned to either the control group or the TEB group, which received a combination of thoracic epidural blockade and general anesthesia.
Measurements
EIT measurements and blood gas analysis were conducted in the lateral position during two-lung ventilation(T0), 15 min after OLV(T1), and 15 min after administration of 0.25 % ropivacaine or 0.9 % saline via epidural delivery during OLV(T2). Hemodynamic and respiratory parameters were recorded, and Dead Space%, Shunt%, and V/Q Match% were calculated based on blood gas analysis and EIT images.
Results
Mean arterial pressure (p < 0.05) significantly decreased 15 min after TEB, while there were no significant changes in heart rate among the 30 patients (p = 0.547). OLV resulted in a significant decrease in arterial oxygen partial pressure/inspired oxygen fraction (PaO2/FiO2) from T0 to T1 in both groups. The PaO2/FiO2 in the TEB group was significantly lower after epidural administration of the local anesthetic (p < 0.05). Shunt- ABG (%) was significantly higher in the TEB group compared to the control group at T2 (p < 0.05). TEB increased non-ventilated perfusion distribution(p < 0.05), and Shunt-EIT % (p < 0.05) and reduced Matched Region % (p < 0.05), while Dead Space-EIT % remained (p = 0.499).
Conclusions
Based on the contrast-enhanced EIT evaluation of pulmonary perfusion and ventilation, TEB appears to induce a V/Q mismatch in patients undergoing OLV in the lateral position for thoracic surgery.
Trial registration: ClinicalTrials.gov, NCT04730089. Registration on January 25th, 2021.
期刊介绍：
The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained.
The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.
京公网安备 11010802042870号
京ICP备2023020795号-1
分享
求助内容：
应助结果提醒方式：
扫码关注我们
