The effects of thoracic epidural analgesia on oxygenation and pulmonary shunt fraction during one-lung ventilation: an meta-analysis

BMC Anesthesiology

Xiao-Qian Li¹  Wen-Fei Tan¹  Jun Wang¹  Bo Fang¹  Hong Ma¹ 

[1] Department of Anesthesiology, First Affiliated Hospital, China Medical University, Shenyang 110001, , Liaoning, China

关键词: Thoracic epidural analgesia;    Pulmonary shunt fraction;    Oxygenation;    One-lung ventilation;   

Others  :  1233934
DOI  :  10.1186/s12871-015-0142-5

 received in 2014-09-23, accepted in 2015-11-10,  发布年份 2015

【 摘 要 】

Background

The aim of our study is to compare the effects of thoracic epidural analgesia combined with general anesthesia (GA) vs. general anesthesia on oxygenation and pulmonary shunt fraction during one-lung ventilation (OLV).

Methods

Literature research was firstly conducted for studies related to comparison of epidural anesthesia combined with GA vs. GA with reporting of hemodynamic and oxygenation variables and published from Jan 1990 to Jan 2014 in EMBAS, MEDLINE and Cochrane Central Register of Controlled Trials databases. The studies were reviewed and data were extracted and analyzed using fixed-effect and random-effect models.

Results

There are 14 trials with 60 separate comparisons enrolling 653 patients for analysis. Regarding systemic hemodynamics, thoracic epidural analgesia decreased the mean arterial pressure and mean pulmonary arterial pressure with weighted mean difference 95 % confidence interval (−6.64 [−9.57 to −3.71] vs. -6.33 [−9.25 to −3.41] and −3.18 [−5.07 to −1.28] vs. -2.05 [−3.35 to −0.75]) respectively at the two measurements time, however, only decreasing heart rate and systemic vascular resistance (−3.28 [−5.98 to −0.67] and −319.99 [−447.05 to −192.94]) over the first 30 min after OLV. For oxygenation variables, thoracic epidural analgesia is associated with significant reduction in partial arterial oxygen pressure, mixed arterial saturation of oxygenation and increased pulmonary venous admixture fraction compared to general anesthesia with weighted mean difference 95 % confidence interval (−16.52 [−21.98 to − 11.05] vs. − 14.23 [−20.81 to − 7.65]), (0.74 [0.33 to 1.15] vs. − 0.63 [−1.23 to −0.04]) and (2.53 [1.35 to 3.72] vs. 2.77 [1.81 to 3.74]) respectively before and after 30 min of one-lung ventilation. A decrease in mixed venous saturation of oxygenation occurred after 30 min of OLV (−2.39 [−3.73 to −0.99]). Besides, a higher mean value of airway pressure was found in the thoracic epidural analgesia with weighted mean difference 95 % confidence interval (1.95 [1.61 to 2.28] vs. 0.87 [0.54 to 1.20]) at the measurements.

Conclusion

Based on the existing limited data puts forward recommendations for cautious usage of thoracic epidural analgesia in case of underlying risks in lower systemic hemodynamics, decreased partial arterial oxygen pressure but increases pulmonary shunt during one-lung ventilation.

【 授权许可】

   
2015 Li et al.

【 图 表 】

Fig. 1.

Fig. 2.

【 参考文献 】

• [1]Karzai W, Schwarzkopf K. Hypoxemia during one-lung ventilation. Curr Opin Anaesthesiol. 2009; 22:1-3.
• [2]Guay J. The benefits of adding epidural analgesia to general anesthesia: a meta analysis. J Anesth. 2006; 20(4):335-40.
• [3]Popping DM, Elia N, Marret E, Remy C, Tramer MR. Protective effects of epidural analgesia on pulmonary complications after abdominal and thoracic surgery. Arch Surg. 2008; 143(10):990-9.
• [4]Lawrence VA, Cornell JE, Smetana GW. Strategies to reduce postoperative pulmonary complications after noncardiothoracic surgery: systematic review of the American College of Physicians. Ann Intern Med. 2006; 114(8):596-608.
• [5]Ozcan PE, Senturk M, Sungur Ulke Z, Toker A, Ozden E, Camci E. Effects of thoracic epidural anaesthesia on pulmonary venous admixture and oxygenation during one-lung ventilation. Acta Anaesthesiol Scand. 2007; 51:1117-22.
• [6]Garutti I, Quintana B, Olmedilla L, Cruz A, Barranco M, Garcia E. Arterial oxygenation during one-lung ventilation: Combined versus general anesthesia. Anesth Analg. 1999; 88:494-9.
• [7]Ishibe Y, Shiokawa Y, Umeda T, Uno H, Nakamura M, Izumi T. The effect of thoracicepidural anesthesia on hypoxic pulmonary vasoconstriction in dog : Ananalysis of the pressure-flow curve. Anesth Analg. 1996; 82:1049-55.
• [8]Jung SM, Cho CK, Kim YJ, Cho HM, Kim CW, Kwon HU et al.. The effect of thoracic epidural anesthesia on pulmonary shunt fraction and arterial oxygenation during one-lung ventilation. J Cardiothorac Vasc Anesth. 2010; 24(3):456-62.
• [9]Garutti I, Cruz P, Olmedilla L, Barrio JM, Cruz A, Fernandez C et al.. Effects of thoracic epidural meperidine on arterial oxygenation during one-lung ventilation in thoracic surgery. J Cardiothorac Vasc Anesth. 2003; 17(3):302-5.
• [10]Von Dossow V, Welte M, Zaune U, Martin E, Walter M, Rückert J et al.. Thoracic epidural anesthesia combined with general anesthesia: the preferred anesthetic technique for thoracic surgery. Anesth Analg. 2001; 92(4):848-54.
• [11]Feng Y, Sun Y, Yang BX. The effect of epidural ropicacaine on arterial oxygenation and intrapulmonary shunt during one-lung ventilation. Chin J Anesthesiol. 2002; 22:143-7.
• [12]Lu JH, Chang YL, Niu L. The effect of epidural anesthesia combined with inhaled anesthesia on oxygenation during one-lung ventilation. Chin J Anesthesiol. 2001; 21:371-2.
• [13]Wang ZY, Luo X, Wang DJ, Ma ZJ. Influence of general-thoracic epidural anaesthesia on intrapulmonary shunt and blood oxygenation during one-lung ventilation. Modem Medical Journal. 2007; 35:390-2.
• [14]Wang GM, Xu H, Zeng YM. The effect of epidural anesthesia combined with propfol intravenous anesthesia on intrapulmonary shunt during one-lung ventilation. Journal of Practical Medicine. 2002; 18:943-4.
• [15]Wang J, Li W, Li Y. The effect of lower thoracic epidural block on intrapulmonary shunt (Qs/Qt) during one-lung ventilation. J Emerg Med. 2004; 9(4):277-9.
• [16]Chen SS, Fang NX, Zhao Q, Zhang J. The effect of thoracic epidural block on atrial oxygenation and intrapulmonary shunt during one-lung ventilation. J clin Anesthesiol. 2002; 18:432-43.
• [17]Wu LD, Zhu XH, Zhou Y, Dong LP, Xu GH. Influence of general anesthesia combined with epidural block on the aged during one-lung ventilation in patients undergoing thoracic surgery. Chinese Journal of Clinical Medicine. 2009; 16:443-5.
• [18]Zhang GX, Wu LD. Clinical observations of influence of general anesthesia combined with epidural block on the aged patients during one-lung ventilation. Acta Academiae Medicineae JiangXi. 2009; 49:84-6.
• [19]Sun Y, Feng Y, Yang BX. Comparison of the effects of isoflurane and propofol in conjunction with thoracic epidural block on oxygenation and shunt fraction during one-lung anesthesia. Chin J Anesthesiol. 2002; 22:403-5.
• [20]Pagel PS, John JL, Damask MC, Davis RF, Samuelson PN, Howie MB et al.. Desflurane and isoflurane produce similar alterations in systemic and pulmonary hemodynamics and arterial oxygenation in patients undergoing one-lung ventilation during thoracotomy. Anesth Analg. 1998; 87:800-7.
• [21]Casati A, Mascotto G, Iemi K, Nzepa-Batonga J, de Luca M. Epidural block does not worsen oxygenation during one-lung ventilation for lung resections under isoflurane/nitrous oxide anesthesia. Euro J Anesth. 2005; 22:363-8.
• [22]Freise H, Meissner A, Lauer S, Aellger B, Radke R, Bruewer M et al.. Thoracic epidural analgesia with low concentration of bupivacaine induces thoracic and lumbar sympathetic block. Anesthesiology. 2008; 109:1107-12.
• [23]Xu YJ, Tan ZM, Wang S, Shao HJ, Zhu XQ. Effect of thoracic epidural anesthesia with different concentration of Ropivacaine on arterial oxygenation during one-lung ventilation. Anesthesiology. 2010; 112:1146-54.
• [24]Moudgil R, Michelakis D, Archer SL. Hypoxic pulmonary vasoconstriction. J Appl Physiol. 2005; 98:390.
• [25]Loepply JA, Scotto P, Riedel CE, Roach RC, Chick TW. Effects of acid/base status on acute pulmonary vasoconstriction and gas exchange. J Appl Physiol. 1993; 72:1787-97.
• [26]Kurilova OA, Vyzhigina MA, Titov VA, Kozlov SP, Zhukova SG, Parshin VD. High level thoracic epidural analgesia as a special component of anesthesia duringthoracic surgeries. Anesteziol Reanimatol. 2011; 10:7.
• [27]Edmark L, Kostova-Aherdan K, Enlund M, Hedenstierna G. Optimal oxygen concentration during induction of general anesthesia. Anesthesiology. 2003; 98:28-33.
• [28]Turnaoglu S, Tugrul M, Camei E, Cakar N, Akinci O, Ergin P. Clinical applicability of the substitution of mixed venous oxygen saturation by central venous saturation. J Cardiothorac Vasc Anesth. 2001; 15:574-9.
• [29]Senturk NM, Dilek A, Camci R, Senturk E, Orhan M, Tugrul M et al.. Effects of positive end-expiratory pressure on ventilatory and oxygenation parameters during pressure-controlled one-lung ventilation. J Cardiothorac Vasc Anesth. 2005; 19:71-5.