A low concentration of desflurane is as useful as propofol for oxygenation during one-lung ventilation in patients undergoing lung cancer surgery, according to a study presented here at ANESTHESIOLOGY 2015, the Annual Meeting of the American Society of Anesthesiologists (ASA).
The concurrent use of inhalational anaesthetics with opioids significantly lowers the concentration required to achieve adequate anaesthetic depth. Since inhibiting hypoxic pulmonary vasoconstriction via inhaled anaesthetics depends on dose, low concentrations of desflurane (< 1 minimum alveolar concentration – MAC) may not significantly inhibit hypoxic pulmonary vasoconstriction, thereby preserving oxygenation during one-lung ventilation.
In the current prospective, randomised study, Izumi Kawagoe, MD, Juntendo University, Tokyo, Japan, and colleagues compared oxygenation with desflurane versus propofol in 160 patients with lung cancer undergoing one-lung ventilation. Patients were randomised to general anaesthesia maintenance with desflurane and remifentanil or to propofol and remifentanil.
General anaesthesia and thoracic epidural anaesthesia were performed identically in both groups, except for the use of desflurane or propofol, and there was no difference between the groups in demographic variables.
The inspiratory desflurane concentration during the first 45 minutes of one-lung ventilation in the desflurane group was 3.7 + – 0.6 %, corresponding to 0.6 +- 0.1 MAC.
Both groups showed similar partial pressure of arterial oxygen (PaO2) immediately before ventilation, and both showed a similar steady decrease in PaO2 until 30 minutes after starting ventilation. PaO2 during ventilation tended to be less in the desflurane group.
The incidence of significant hypoxia– defined as PaO2 <80 mm Hg — during the first 45 minutes of ventilation was also similar between the groups.[Presentation title: A Low Concentration of Desflurane Is Not Inferior to Propofol in Oxygenation During One-Lung Ventilation in Patients Undergoing Lung Cancer Surgery – a Prospective, Randomized Study. Abstract A1224]