Nebulized dexmedetomidine improves pulmonary shunt and lung mechanics during one-lung ventilation: a randomized clinical controlled trial
Background Dexmedetomidine (Dex), a selective a2-adrenergic receptor agonist, has been previously reported to attenuate intrapulmonary shunt during one-lung ventilation (OLV) and to alleviate bronchoconstriction. However, the therapeutic effects of nebulized Dex on pulmonary shunt and lung mechanics...
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PeerJ Inc.
2020-06-01
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| Online Access: | https://peerj.com/articles/9247.pdf |
| _version_ | 1827608993591197696 |
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| author | Bo Xu Hong Gao Dan Li Chunxiao Hu Jianping Yang |
| author_facet | Bo Xu Hong Gao Dan Li Chunxiao Hu Jianping Yang |
| author_sort | Bo Xu |
| collection | DOAJ |
| description | Background Dexmedetomidine (Dex), a selective a2-adrenergic receptor agonist, has been previously reported to attenuate intrapulmonary shunt during one-lung ventilation (OLV) and to alleviate bronchoconstriction. However, the therapeutic effects of nebulized Dex on pulmonary shunt and lung mechanics during OLV have not been evaluated. Here we determine whether nebulized dexmedetomidine improved pulmonary shunt and lung mechanics in patients undergoing elective thoracic surgery in a prospective randomized controlled clinical trial. Methods One hundred and twenty-eight patients undergoing elective thoracoscopic surgery were included in this study and randomly divided into four groups: 0.9% saline (Placebo group), 0.5 µg/kg (Dex0.5 group), 1 µg/kg (Dex1 group) and 2 µg/kg (Dex2group) dexmedetomidine. After bronchial intubation, patients received different nebulized doses of dexmedetomidine (0.5 µg/kg, 1 µg/kg and 2 µg/kg) or 0.9% saline placebo during two-lung ventilation(TLV). OLV was initiated 15 min after bronchial intubation. Anesthesia was maintained with intravenous infusion of cisatracurium and propofol. Bispectral Index values were maintained within 40–50 by adjusting the infusion of propofol in all groups. Arterial blood gas samples and central venous blood gas samples were taken as follows: 15 min after bronchial intubation during two-lung ventilation (TLV15), after 30 and 60 min of OLV (OLV30and OLV60, respectively) and 15 min after reinstitution of TLV (ReTLV). Dynamic compliance was also calculated at TLV15, OLV30, OLV60 and ReTLV. Results Dex decreased the requirement of propofol in a dose-dependent manner(P = 0.000). Heart rate (HR) and mean arterial pressure (MAP) displayed no significant difference among groups (P = 0.397 and 0.863). Compared with the placebo group, Dex administered between 0.5 and 2 µg/kg increased partial pressure of oxygen (PaO2) significantly at OLV30 and OLV60(P = 0.000); however, Dex administered between 1 and 2 µg/kg decreased pulmonary shunt fraction (Qs/Qt) at OLV30 and OLV60(P = 0.000). Compared with the placebo group, there were significant increases with dynamic compliance (Cdyn) after OLV in Dex0.5, Dex1 and Dex2group(P = 0.000). Conclusions. Nebulized dexmedetomidine improved oxygenation not only by decreasing pulmonary shunt but also by improving lung compliance during OLV, which may be effective in managing OLV. |
| first_indexed | 2024-03-09T07:23:39Z |
| format | Article |
| id | doaj.art-1cbc8ec8f689480e83062e9cb56423cf |
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| issn | 2167-8359 |
| language | English |
| last_indexed | 2024-03-09T07:23:39Z |
| publishDate | 2020-06-01 |
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| spelling | doaj.art-1cbc8ec8f689480e83062e9cb56423cf2023-12-03T07:09:59ZengPeerJ Inc.PeerJ2167-83592020-06-018e924710.7717/peerj.9247Nebulized dexmedetomidine improves pulmonary shunt and lung mechanics during one-lung ventilation: a randomized clinical controlled trialBo Xu0Hong Gao1Dan Li2Chunxiao Hu3Jianping Yang4The Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, ChinaThe Department of Anesthesiology, The Affiliated Wuxi People‘s Hospital of Nanjing Medical University, Wuxi, Jiangsu, ChinaThe Department of Anesthesiology, The Affiliated Wuxi People‘s Hospital of Nanjing Medical University, Wuxi, Jiangsu, ChinaThe Department of Anesthesiology, The Affiliated Wuxi People‘s Hospital of Nanjing Medical University, Wuxi, Jiangsu, ChinaThe Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, ChinaBackground Dexmedetomidine (Dex), a selective a2-adrenergic receptor agonist, has been previously reported to attenuate intrapulmonary shunt during one-lung ventilation (OLV) and to alleviate bronchoconstriction. However, the therapeutic effects of nebulized Dex on pulmonary shunt and lung mechanics during OLV have not been evaluated. Here we determine whether nebulized dexmedetomidine improved pulmonary shunt and lung mechanics in patients undergoing elective thoracic surgery in a prospective randomized controlled clinical trial. Methods One hundred and twenty-eight patients undergoing elective thoracoscopic surgery were included in this study and randomly divided into four groups: 0.9% saline (Placebo group), 0.5 µg/kg (Dex0.5 group), 1 µg/kg (Dex1 group) and 2 µg/kg (Dex2group) dexmedetomidine. After bronchial intubation, patients received different nebulized doses of dexmedetomidine (0.5 µg/kg, 1 µg/kg and 2 µg/kg) or 0.9% saline placebo during two-lung ventilation(TLV). OLV was initiated 15 min after bronchial intubation. Anesthesia was maintained with intravenous infusion of cisatracurium and propofol. Bispectral Index values were maintained within 40–50 by adjusting the infusion of propofol in all groups. Arterial blood gas samples and central venous blood gas samples were taken as follows: 15 min after bronchial intubation during two-lung ventilation (TLV15), after 30 and 60 min of OLV (OLV30and OLV60, respectively) and 15 min after reinstitution of TLV (ReTLV). Dynamic compliance was also calculated at TLV15, OLV30, OLV60 and ReTLV. Results Dex decreased the requirement of propofol in a dose-dependent manner(P = 0.000). Heart rate (HR) and mean arterial pressure (MAP) displayed no significant difference among groups (P = 0.397 and 0.863). Compared with the placebo group, Dex administered between 0.5 and 2 µg/kg increased partial pressure of oxygen (PaO2) significantly at OLV30 and OLV60(P = 0.000); however, Dex administered between 1 and 2 µg/kg decreased pulmonary shunt fraction (Qs/Qt) at OLV30 and OLV60(P = 0.000). Compared with the placebo group, there were significant increases with dynamic compliance (Cdyn) after OLV in Dex0.5, Dex1 and Dex2group(P = 0.000). Conclusions. Nebulized dexmedetomidine improved oxygenation not only by decreasing pulmonary shunt but also by improving lung compliance during OLV, which may be effective in managing OLV.https://peerj.com/articles/9247.pdfNebulizerArterial oxygenationIntrapulmonary shuntLung mechanicsOne-lung ventilationThoracic surgery |
| spellingShingle | Bo Xu Hong Gao Dan Li Chunxiao Hu Jianping Yang Nebulized dexmedetomidine improves pulmonary shunt and lung mechanics during one-lung ventilation: a randomized clinical controlled trial PeerJ Nebulizer Arterial oxygenation Intrapulmonary shunt Lung mechanics One-lung ventilation Thoracic surgery |
| title | Nebulized dexmedetomidine improves pulmonary shunt and lung mechanics during one-lung ventilation: a randomized clinical controlled trial |
| title_full | Nebulized dexmedetomidine improves pulmonary shunt and lung mechanics during one-lung ventilation: a randomized clinical controlled trial |
| title_fullStr | Nebulized dexmedetomidine improves pulmonary shunt and lung mechanics during one-lung ventilation: a randomized clinical controlled trial |
| title_full_unstemmed | Nebulized dexmedetomidine improves pulmonary shunt and lung mechanics during one-lung ventilation: a randomized clinical controlled trial |
| title_short | Nebulized dexmedetomidine improves pulmonary shunt and lung mechanics during one-lung ventilation: a randomized clinical controlled trial |
| title_sort | nebulized dexmedetomidine improves pulmonary shunt and lung mechanics during one lung ventilation a randomized clinical controlled trial |
| topic | Nebulizer Arterial oxygenation Intrapulmonary shunt Lung mechanics One-lung ventilation Thoracic surgery |
| url | https://peerj.com/articles/9247.pdf |
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