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Objective: The purpose of this study was to investigate the relationship between the ventilatory mode used during one-lung ventilation (OLV) and intraoperative and early postoperative arterial oxygenation in patients undergoing thoracic surgery., Methods: A prospective, randomized clinical trial., Setting: A tertiary care university hospital single institution., Participants: One hundred ten patients scheduled for thoracic surgery with at least 1 hour of OLV., Interventions: Patients were prospectively randomized into 2 groups depending on the ventilatory mode used during OLV: volume-controlled ventilation (VCV) or pressure-controlled ventilation (PCV). In VCV, the authors used a tidal volume (Vt) of 8 mL/kg and in the PCV group an inspiratory pressure to provide a tidal volume of 8 mL/kg., Measurements and Main Results: Airway pressures and arterial blood gases were obtained at 20, 30, and 40 minutes after OLV. The authors recorded the ratio of arterial oxygen tension to inspired oxygen fraction (PaO(2)/F(I)O(2)) at 4 hours (RU1) and 24 hours (RU2) after surgery. During OLV, there were no differences in arterial oxygenation, airway plateau pressure, and mean pressure between groups, although peak pressure was higher in the VCV group (p < 0.01). The PaO(2)/F(I)O(2) ratio at RU1 was 312.6 +/- 106 in the VCV group and 322.1 +/- 104. In the PCV group at RU2, it was 402.4 +/- 105 and 389.6 +/- 114, respectively, and there were no significant differences between the groups., Conclusions: In patients undergoing thoracic surgery, the use of PCV compared with VCV during OLV with the same Vt of 8 mL/kg does not affect arterial oxygenation during OLV or early postoperative oxygenation.

Objective: The objective of the present study was to investigate respiratory and hemodynamic changes by measuring continuous cardiac output, cardiac filling, and stroke volume variation after lung recruitment in thoracic surgery., Design: A prospective, observational study., Setting: A tertiary care university hospital single institution., Participants: Forty patients undergoing thoracotomy for lung resection with at least 1 hour of one-lung ventilation (OLV)., Interventions: During OLV, an alveolar recruitment maneuver (ARM) was performed., Measurements and Main Results: Based on Edwards Vigileo/FloTrac system (Edwards Lifesciences, Irvine, CA), the arterial pressure-based cardiac output, cardiac index, systemic vascular resistance, stroke volume variation, and central venous oxygen saturation were recorded immediately before the maneuver and 1, 2, 3, 4, 5, and 10 minutes after the maneuver. Stroke volume variation was the parameter most affected during and after the maneuver; it increased to 50% and 40% in the first and second minute, respectively (p < 0.01). The cardiac index was also affected and decreased 9.4% (p < 0.05) in the first minute after the maneuver. ScvO2 decreased significantly during the first 2 minutes (7% and 6.5%, respectively). However, after 3 minutes, all values recorded were similar to prerecruitment values. The PaO2 and PcvO2 from samples taken 10 minutes after the maneuver improved considerably with respect to the values before alveolar recruitment., Conclusions: The authors concluded that during open-chest surgery with OLV, an ARM effectively improved oxygenation without inducing important circulatory changes.

Objective: This study was designed to determine whether ropivacaine plus fentanyl was as effective as bupivacaine plus fentanyl in a continuous thoracic paravertebral block after posterolateral thoracotomy., Design: Patients were randomly assigned in a blinded fashion to receive 1 of 2 solutions for paravertebral analgesia., Setting: Multi-institutional university hospital., Participants: Sixty patients undergoing elective thoracotomy., Interventions: A continuous paravertebral infusion of 0.1 mL/kg/h of either 0.3% ropivacaine/fentanyl, 3 microg/mL, or 0.25% bupivacaine/fentanyl, 3 microg/mL, was started on admission to the intensive care unit., Measurements and Main Results: Pain scores (rest, deep breathing, and coughing), spirometry, subcutaneous opioids, or nonsteroidal anti-inflammatory drug consumption and adverse events were assessed for 48 hours. Both techniques provided adequate pain relief for the first 2 days after posterolateral thoracotomy. There were no differences between groups in pain scores at rest, coughing, or movement. There was an improvement of spirometry values between the first and second day in both groups. There were no differences in the requirements for rescue analgesia and side effects between groups., Conclusions: It is concluded that both bupivacaine, 0.25%, and ropivacaine, 0.3%, with fentanyl are equally effective for post-thoracotomy pain control when used via continuous paravertebral blockade.

Objective: There is increasing interest in the use of the thoracic paravertebral block (TPVB) in association with general anesthesia for lung-resection surgery. The aim of the study was to evaluate the hemodynamic effects of a 5-mg/kg lidocaine bolus injected in the thoracic paravertebral space during one-lung ventilation (OLV) in noncardiac patients undergoing thoracic surgery., Design: Prospective, observational study., Setting: Tertiary care university hospital., Participant: Twenty patients undergoing thoracotomy for lung resection., Interventions: In addition to standard monitoring, cardiac output, preload parameters (global diastolic volume, total intrathoracic blood volume, and systolic volume variation), and myocardial contractility (dP(max) and cardiac function index) were measured with an aortic transpulmonary thermodilution technique., Measurements and Main Results: After OLV initiation, a paravertebral lidocaine bolus of 5 mg/kg (2%) caused decreases in the dP(max) and cardiac function index that lasted up to 30 minutes. Accompanying minor reductions in heart rate and systolic blood pressure required no vasoactive drugs and were self-limiting. None of the other hemodynamic parameters studied was significantly altered., Conclusions: In noncardiac patients, TPVB is associated with good hemodynamic stability, despite a small and transient decrease in myocardial contractility that could be related to the drug's systemic effects after its absorption.

Objective: To compare the effects that the use of general intravenous anesthesia (propofol-fentanyl) (GA) or general anesthesia combined with thoracic epidural anesthesia with meperidine (TEA-M) may have on arterial oxygenation during one-lung ventilation (OLV)., Design: Prospective., Setting: Tertiary care hospital., Participants: Seventy-two patients undergoing OLV for thoracic surgery., Interventions: Patients were prospectively randomized into two groups: GA (n = 37) fentanyl, propofol, rocuronium anesthesia was used; and group TEA-M (n = 35) were anesthetized with propofol, rocuronium and thoracic epidural meperidine (2 mg/kg in 10-12 mL) administered before anesthetic induction. A double-lumen endotracheal tube was inserted, and mechanical ventilation with 100% oxygen was used during study. Mean arterial pressure, heart rate and arterial and venous blood gases were recorded with the patients in the lateral decubitus position in three phases: during two-lung ventilation (TLV), 15 and 30 minutes after beginning OLV (OLV + 15 and OLV + 30 respectively). The authors measured arterial and venous central oxygen tension, arterial and venous central oxygen saturation, arterial and venous central oxygen content and venous admixture percentage (Qs/Qt%)., Measurements and Main Results: There were no statistical differences between the two groups for PaO(2) during OLV + 15 (GA = 165 mmHg, TEA-M = 153 mmHg) and OLV + 30 (GA = 176 mmHg, TEA-M = 158 mmHg); and with values for Qs/Qt%., Conclusions: It is concluded that GA combined with TEA-M (2 mg/kg) do not affect arterial oxygenation during OLV in thoracic surgery.