Effects of Thoracic Epidural Anesthesia Combined with General Anesthesia on Arterial Oxygenation and Intrapulmonary Shunting during One-Lung Ventilation: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

ZENG Zhiying ,  PAN Linghui , LIN Fei

Department of Anesthesiology, Affiliated Tumor Hospital, Guangxi Medical University, Naning 530021, China;

Corresponding author：

PAN Linghui, Email: plinghui@yahoo.com.cn

Keywords：

Anesthesia, General; Analgesia, Epidural; One-lung ventilation; Intrapulmonary shunting; Randomized controlled trial; Systematic review

DOI：

10.7507/1672-2531.20100611

Video：

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Objective 　To evaluate the effectiveness of thoracic epidural anesthesia (TEA) combined with general anesthesia (GA) versus GA alone on intrapulmonary shunting during one-lung ventilation (OLV).
Methods 　We searched the Cochrane Library (Issue 4, 2009), the specialized trials registered in the Cochrane anesthesia group, PubMed (1966 to Dec. 2009), EMbase (1966 to Dec. 2008), CBM (1978 to Dec. 2009), VIP (1989 to Dec. 2009), CNKI (1915 to Dec. 2009), and handsearched Clinical Anesthesia Journal and Chinese Anesthesia Journal. Randomized controlled trials (RCTs) about the effectiveness of TEA combined with GA versus GA alone on intrapulmonary shunting during OLV were included, The methodological quality of included RCTs was evaluated by two reviewers independently, Meta-analysis was conducted using RevMan 5.0 software.
Results 　Ten RCTs involving 506 patients were included. The results of meta-analyses showed that there were no significant differences in intrapulmonary shunting during OLV at different times-points of 5, 15, 20, 30, and 60 minutes after OLV.
Conclusion 　Both TEA combined with GA and GA alone have the same Security during OLV. But owing to the low quality and small sample size of the included studies, further more well-designed, large sample size RCTs are needed.

Citation： ZENG Zhiying,PAN Linghui,LIN Fei. Effects of Thoracic Epidural Anesthesia Combined with General Anesthesia on Arterial Oxygenation and Intrapulmonary Shunting during One-Lung Ventilation: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2010, 10(12): 1450-1455. doi: 10.7507/1672-2531.20100611 Copy

1.	Ignacio G, Begona Q, Luis O, et al. Arterial oxgenaton during one lung ventilation: combined versus general anesthesia. J Anesth Analg, 1999, 88(7): 494-499.
2.	Kellow N, Scott A, White SA, et al. Comparison of the effects of propofol and isoflurane on right ventricular function and shunt fraction duirng thoracic surgery. Br J Anesth, 1995, 75(5): 578-582.
3.	林文前, 李伟, 曾维安, 等. 全麻复合硬膜外阻滞对单肺通气期间肺内分流的影响. 临床麻醉学杂志, 2002.1(3): 121.
4.	IsbibeY, ShiokawaY, Umeda T, et al. The effect of thoracic epidural anesthesia on hypoxic pulmonary vasoconstriction in dog: an analysis of the pressure-flow curve. J Anesht Analg, 1996, 82: 1049.
5.	Jung SM, Cho CK, Kim YJ, et al. The effect of thoracic epidural anesthesia on pulmonary shunt fraction and arterial oxygenation during one-lung ventilation. J Cardiothorac Vasc Anesth, 2010, 24(3): 456-462.
6.	阮林, 温文钊, 黄冰, 等. 胸段硬膜外麻醉对单肺通气肺内分流的影响. 广西医科大学学报, 2000, 17(1): 43.
7.	王喆妍, 骆旋, 王东进, 等. 胸段硬膜外阻滞复合全麻对单肺通气患者肺内分流和动脉氧合的影响. 现代医学, 2007, 35(5): 392.
8.	冯艺, 孙颖, 杨拔贤, 等. 硬膜外阻滞对全麻单肺通气期间肺内分流和氧合的影响. 中华麻醉学杂志, 2002, 22(3): 143.
9.	Ozcan PE, Sentürk M, Sungur Ulke Z, et al. Effects of thoracic epidural anaesthesia on pulmonary venous admixture and oxygenation during one-lung ventilation. Acta Anaesthesiol Scand, 2007, 51(8): 1117-1122.
10.	王公明, 许华, 曾因明, 等. 胸段硬膜外阻滞复合异丙酚静脉全麻对单肺通气肺内分流的影响. 实用医学杂志, 2002, 18(9): 943-944.
11.	王剑, 李伟, 李毅, 等. 下胸段硬膜外阻滞在单肺通气期间对肺内分流的影响. 岭南急诊医学杂志, 2004, 9(4): 277-279.
12.	彭从斌, 林学正, 王军会, 等. 硬膜外阻滞对全麻单肺通气期间血液动力学及肺内分流的影响.中华麻醉学杂志, 2004.24(2): 148-149.
13.	Garutti I, Cruz P, Olmedilla L, et al. Effects of thoracic epidural meperidine on arterial oxygenation during one-lung ventilation in thoracic surgery. J Cardiothorac Vasc Anesth, 2003, 17(3): 302-305.
14.	Von Dossow V, Welte M, Zaune U, et al. Thoracic epidural anesthesia combined with general anesthesia: the preferred anesthetic technique for thoracic surgery. Anesth Analg, 2001, 92(4): 848-854.
15.	陈鹏, 韩阳东, 王天元, 等. 艾司洛尔预防气管插管时的心血管反应. 白求恩医科大学学报, 2003, 26(3): 299-300.
16.	Ishiyama T, Kashimoto S, Oguchi T, et al. Epidural ropivacaine anesthesia decreases the bispectral index during the awake phase and sevoflurane general anesthesia. Anesth Analg, 2005, 100(3): 728-732.
17.	Slinger P, Shennib H, Wilson S. Postthoracotomy pulmonary function: a comparison of epidural versus intravenous meperidine infusions. J Cardiothorac Vasc Anesth, 1995, 9(2): 128-134.
18.	赵子良, 董庆龙. 全麻联合硬膜外阻滞与单纯全麻在胸科手术麻醉效果的比较. 实用医技杂志, 2006, 13(l1): 1904-1905.
19.	安珂, 董铁立, 王春亭. 单肺通气期问胸部硬膜外麻醉对肺内分流的影响. 实用医学进修杂志, 2004, 32(3): 174-176.
20.	Bracco D, Noiseux N, Dubois MJ, et al. Epidural anesthesia improves outcome and resource use in cardiac surgery: a single-center study of a 1293-patient cohort. Heart Surg Forum, 2007, 10(6): E449-458.
21.	Chow MY, Goh MH, Boey SK, et al. The effects of remifentanil and thoracic epidural on oxygenation and pulmonary shunt fraction during one-lung ventilation. J Cardiothorac Vasc Anesth, 2003, 17(1): 69-72.
22.	Park WY, Thompson JS, Lee KK. Effect of epidural anesthesia and analgesia on perioperative outcome: a randomized, controlled Veterans Affairs cooperative study. Ann Surg, 2001, 234(4):560-569; discussion 569-571.

1. Ignacio G, Begona Q, Luis O, et al. Arterial oxgenaton during one lung ventilation: combined versus general anesthesia. J Anesth Analg, 1999, 88(7): 494-499.
2. Kellow N, Scott A, White SA, et al. Comparison of the effects of propofol and isoflurane on right ventricular function and shunt fraction duirng thoracic surgery. Br J Anesth, 1995, 75(5): 578-582.
3. 林文前, 李伟, 曾维安, 等. 全麻复合硬膜外阻滞对单肺通气期间肺内分流的影响. 临床麻醉学杂志, 2002.1(3): 121.
4. IsbibeY, ShiokawaY, Umeda T, et al. The effect of thoracic epidural anesthesia on hypoxic pulmonary vasoconstriction in dog: an analysis of the pressure-flow curve. J Anesht Analg, 1996, 82: 1049.
5. Jung SM, Cho CK, Kim YJ, et al. The effect of thoracic epidural anesthesia on pulmonary shunt fraction and arterial oxygenation during one-lung ventilation. J Cardiothorac Vasc Anesth, 2010, 24(3): 456-462.
6. 阮林, 温文钊, 黄冰, 等. 胸段硬膜外麻醉对单肺通气肺内分流的影响. 广西医科大学学报, 2000, 17(1): 43.
7. 王喆妍, 骆旋, 王东进, 等. 胸段硬膜外阻滞复合全麻对单肺通气患者肺内分流和动脉氧合的影响. 现代医学, 2007, 35(5): 392.
8. 冯艺, 孙颖, 杨拔贤, 等. 硬膜外阻滞对全麻单肺通气期间肺内分流和氧合的影响. 中华麻醉学杂志, 2002, 22(3): 143.
9. Ozcan PE, Sentürk M, Sungur Ulke Z, et al. Effects of thoracic epidural anaesthesia on pulmonary venous admixture and oxygenation during one-lung ventilation. Acta Anaesthesiol Scand, 2007, 51(8): 1117-1122.
10. 王公明, 许华, 曾因明, 等. 胸段硬膜外阻滞复合异丙酚静脉全麻对单肺通气肺内分流的影响. 实用医学杂志, 2002, 18(9): 943-944.
11. 王剑, 李伟, 李毅, 等. 下胸段硬膜外阻滞在单肺通气期间对肺内分流的影响. 岭南急诊医学杂志, 2004, 9(4): 277-279.
12. 彭从斌, 林学正, 王军会, 等. 硬膜外阻滞对全麻单肺通气期间血液动力学及肺内分流的影响.中华麻醉学杂志, 2004.24(2): 148-149.
13. Garutti I, Cruz P, Olmedilla L, et al. Effects of thoracic epidural meperidine on arterial oxygenation during one-lung ventilation in thoracic surgery. J Cardiothorac Vasc Anesth, 2003, 17(3): 302-305.
14. Von Dossow V, Welte M, Zaune U, et al. Thoracic epidural anesthesia combined with general anesthesia: the preferred anesthetic technique for thoracic surgery. Anesth Analg, 2001, 92(4): 848-854.
15. 陈鹏, 韩阳东, 王天元, 等. 艾司洛尔预防气管插管时的心血管反应. 白求恩医科大学学报, 2003, 26(3): 299-300.
16. Ishiyama T, Kashimoto S, Oguchi T, et al. Epidural ropivacaine anesthesia decreases the bispectral index during the awake phase and sevoflurane general anesthesia. Anesth Analg, 2005, 100(3): 728-732.
17. Slinger P, Shennib H, Wilson S. Postthoracotomy pulmonary function: a comparison of epidural versus intravenous meperidine infusions. J Cardiothorac Vasc Anesth, 1995, 9(2): 128-134.
18. 赵子良, 董庆龙. 全麻联合硬膜外阻滞与单纯全麻在胸科手术麻醉效果的比较. 实用医技杂志, 2006, 13(l1): 1904-1905.
19. 安珂, 董铁立, 王春亭. 单肺通气期问胸部硬膜外麻醉对肺内分流的影响. 实用医学进修杂志, 2004, 32(3): 174-176.
20. Bracco D, Noiseux N, Dubois MJ, et al. Epidural anesthesia improves outcome and resource use in cardiac surgery: a single-center study of a 1293-patient cohort. Heart Surg Forum, 2007, 10(6): E449-458.
21. Chow MY, Goh MH, Boey SK, et al. The effects of remifentanil and thoracic epidural on oxygenation and pulmonary shunt fraction during one-lung ventilation. J Cardiothorac Vasc Anesth, 2003, 17(1): 69-72.
22. Park WY, Thompson JS, Lee KK. Effect of epidural anesthesia and analgesia on perioperative outcome: a randomized, controlled Veterans Affairs cooperative study. Ann Surg, 2001, 234(4):560-569; discussion 569-571.

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Effects of Thoracic Epidural Anesthesia Combined with General Anesthesia on Arterial Oxygenation and Intrapulmonary Shunting during One-Lung Ventilation: A Systematic Review

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