Abstract
Arterial oxygenation is regularly impaired during one-lung anaesthesia, that is ventilation only in the dependent lung with the patient in the lateral position. This has often been attributed to persisting blood flow through the nondependent lung and efforts have been avocated to minimize this blood flow. However, success has been limited, indicating additional causes of gas exchange impairment, residing in the dependent lung. Recently, prompt collapse of dependent lung regions has been demonstrated on induction of general anaesthesia. The collapsed area has been named compression atelectasis to indicate that it is not caused by closure of airways and slow resorption of gas but rather to reduction of thoracic volume. The atelectasis causes shunt which may be the only or the major cause of gas exchange impairment during anaesthesia. Positive end-expiratory pressure applied to the nondependent lung forces blood flow to the dependent lung and may increase perfusion of the atelectatic region. PEEP to the dependent lung to counter lung collapse will force blood flow to the nondependent, nonventilated lung. Thus, measures to improve arterial oxygenation during one-lung anaesthesia should be directed towards both lungs, reducing blood flow through the upper, nonventilated lung and countering collapse in the dependent lung. The way to achieve this remains to be found.
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References
Alfery DD, Benumof JL, Trousdale FR (1981) Improving oxygenation during one-lung ventilation in dogs: The effects of positive end-expiratory pressure and blood flow restriction to nonventilated lung. Anesthesiology 55: 381–385
Bjork VO (1953) Circulation through atelectatic lung in man. J Thorac Surg 26: 533–543
Brismar B, Hedenstierna G, Lundquist H, Strandberg A, Svensson L, Tokics L (1985) Pulmonary densities during anesthesia with muscular relaxation - a proposal of atelectasis. Anesthesiology 62: 422–428
Capan LM, Turndorf H, Patel C (1980) Optimization of hypoxemia and intrapulmonary shunting during one-lung anesthesia. Anesth Analg (Cleve) 59: 847–851
Craig JOC, Bromley LL, Williams R (1962) Thoracotomy and contralateral lung. A study of the changes occurring in the dependent and contralateral lung during and after thoracotomy in lateral decubitus. Thorax 17: 9–15
Flacke JW, Thompson DS, Read RC (1976) Influence of tidal volume and pulmonary artery occlusion on arterial oxygenation during endobronchial anesthesia. South Med J 69: 619–626
Hedenstierna G, Baehrendtz S, Klingstedt C, Santesson J, Soderborg B, Dahlborn M, Bindslev L (1984) Ventilation and perfusion of each lung during differential ventilation with selective PEEP. Anesthesiology 61 : 369–376
Katz JA, Laverne RG, Fairley HB, Thomas AN (1982) Pulmonary oxygen exchange during endobronchial anesthesia: Effect of tidal volume and PEEP. Anesthesiology 56: 164–171
Kerr JH (1982) Physiological aspects of one-lung (endobronchial) anesthesia. Int Anesthesiol Clin 10: 61–78
Khanam T, Branthwaite MA (1973) Arterial oxygenation during one-lung anesthesia (1): a study in man. Anaesthesia 28: 132–138
Obara H, Tanaka 0, Hoshino Y, Kaetsu H, Maekawa N, Iwai S (1986) One-lung ventilation. The effect of positive end expiratory pressure to the nondependent and dependent lun g. Anaesthesia 41: 1007–1010
Strandberg A, Brismar B, Hedenstierna G, Lundquist H, Tokics L (1986) Atelectasis during anaesthesia and in the postoperative period. Acta Anaesthesiol Scand 30: 154–158
Tharhan S, Lundborg RO (1968) Blood gas and pH studies during use of the Carlens catheter. Can Anaesth Soc J 15: 458–467
Tharhan S, Lundborg RO (1970) Effects of increased expiratory pressure on blood gas tensions and pulmonary shunting during thoracotomy with use of the Carlens catheter. Can Anaesth Soc J 17: 4–11
Tokics L, Hedenstierna G, Stransberg A, Brismar B, Lundquist H (1987) Lung collapse and gas exchange during general anesthesia - effects of spontaneous breathing, muscle paralysis and positive end-expiratory pressure. Anesthesiology 66: 157–167
Torda TA, McCulloch CH, O’Brien HD (1974) Pulmonary venous admixture during onelung anesthesia. The effect of inhaled oxygen tension and respiration rate. Anaesthesia 29: 272–279
West JB, Dollery CT, Naimark C (1964) Distribution of blood flow in isolated lung: relation to vascular and alveolar pressure. J Appl Physiol 19: 713–724
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© 1988 Springer-Verlag Berlin Heidelberg
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Hedenstierna, G., Klingstedt, C. (1988). Oxygenation During One-Lung Anaesthesia. In: Peter, K., Groh, J. (eds) ZAK München 1987. Anaesthesiologie und Intensivmedizin / Anaesthesiology and Intensive Care Medicine, vol 205. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-73785-5_37
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DOI: https://doi.org/10.1007/978-3-642-73785-5_37
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-19385-2
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