The Association Between the Initial End-Tidal Carbon Dioxide Difference and the Lowest Arterial Oxygen Tension Value Obtained During One-Lung Anesthesia With Propofol or Sevoflurane

Fukuoka, Naokazu; Iida, Hiroki; Akamatsu, Shigeru; Nagase, Kiyoshi; Iwata, Hisashi; Dohi, Shuji

doi:10.1053/j.jvca.2009.03.023

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Volume 23, Issue 6 , Pages 775-779, December 2009

The Association Between the Initial End-Tidal Carbon Dioxide Difference and the Lowest Arterial Oxygen Tension Value Obtained During One-Lung Anesthesia With Propofol or Sevoflurane

Presented in brief at the 2007 Annual Meeting of the American Society of Anesthesiologists, San Francisco, CA, October 13, 2007.

Naokazu Fukuoka, MD
- Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
Hiroki Iida, MD
- Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
- Address reprint requests to Hiroki Iida, MD, Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu-City, Gifu 501-1194, Japan
Shigeru Akamatsu, MD
- Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
Kiyoshi Nagase, MD
- Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
Hisashi Iwata, MD
- Department of Advanced Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
Shuji Dohi, MD
- Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine, Gifu, Japan

published online 05 June 2009.

Objective

The purpose of this study was to examine the correlation between the lowest PaO₂ value recorded during the first 45 minutes of one-lung ventilation (OLV) and the end-tidal CO₂ (ETCO₂) difference between two-lung ventilation (TLV) and the early phase of OLV.

Design

A prospective, randomized study.

Setting

A university hospital.

Participants

Thirty-six patients scheduled for elective thoracic surgery.

Interventions

Thoracic surgery patients were randomly assigned to 1 of 2 groups (group P [n = 18], maintained with propofol; group S [n = 18], maintained with sevoflurane). After setting up, the authors measured arterial blood gases at F_IO₂ = 1.0 as follows: during TLV and at 5 minutes, 15 minutes, 30 minutes, and 45 minutes after the start of OLV. ETCO₂ was recorded just before and at 3 minutes after the start of OLV. The authors examined the relationship between the initial ETCO₂ difference and the lowest PaO₂ value recorded during the first 45 minutes of OLV.

Measurements and Main Results

There was a significant negative correlation between the lowest PaO₂ (x) value and the initial ETCO₂ difference (y) during OLV in each group (group P: y = −0.0203x + 7.2571, r² = 0.5351; group S: y = −0.0257x + 7.3158, r² = 0.6129). This correlation was not significantly different between the groups.

Conclusion

The present study indicates that the ETCO₂ difference between TLV and early OLV has an association with impaired oxygenation later during OLV. This would be a simple and clinically convenient predictor of the lowest PaO₂ value likely to be reached during one-lung anesthesia with either propofol or sevoflurane.

Key Words: one-lung ventilation, oxygenation, end-tidal carbon dioxide, propofol, sevoflurane