Abstract
The mechanism which normally affects distribution of blood flow through unventilated areas of the lung is hypoxic pulmonary vasoconstriction; this acts to divert the blood to well ventilated alveoli, resulting in a better ratio of ventilation to perfusion. Several reports have focused attention on the reduction or abolition of this reflex in the unventilated lung by most of the volatile anaesthetic agents used in clinical practice. This response was not abolished by the intravenous anaesthetic agents.
One hundred and ten patients undergoing elective pulmonary resection were studied to evaluate the effect of a continuous infusion of ketamine during one-lung anaesthesia, by observing the changes in Pa02as a reflection of shunt. Ketamine was chosen as the intravenous agent for its positive inotropic and chronotropic action. Additionally, by providing both analgesia and hypnosis, we were able to admininster inspired oxygen concentrations of 50-100 per cent without concern that the patient might have recall for events during operation We have demonstrated that in all cases a Pa02 in excess of 9.31 kPa (70 torr) was achieved with ketamine and Fi021 .0as well as an increase in shunt fraction from 25.9 per cent (Fi020.5) to 36.0 per cent (Fi02 1.0).
We feel that ketamine provides a satisfactory alternative to the volatile agents for one-lung anaesthesia in patients where relative hypoxaemia might be unacceptable during operation.
RéSUMé
La vasoconstriction pulmonaire réflexe à l’hypoxie constitue le mécanisme normal qui vient modifier la distribution du volume sanguin dans les régions non ventilées du poumon. Ceci permet de déevier le flot sanguin vers les alvéoles bien ventilees et d’améliorer le rapport ventilation-perfusion.
Plusieurs travaux ont faut etat de l’abolition de la diminution de ce reflexe, dans les regions du poumon non ventilées, par la plupart des agents volatils d’usage courant, alors que les anesthésiques intraveineux ne l’abolissent pas.
Nous avons étudié 110 opérés subissant une pneumonectomie élective, dans le but d’évaluer I’influence d’une perfusion continue de kétamine au cours d’anesthésies à un poumon. Les modifications de la Pa02 étaient utilisées comme reflets du shunt. Le choix de la kétamine comme agent d’anesthésie a été basé sur ses propriétés inotropes et chronotropes. En plus de fournir a la fois l’analgésie et l’amnésie, cet agent nous permettait d’administrer de Toxygène à des concentrations de 50 à 100 pour cent sans crainte de mémorisation de la chirurgie par le patient. Dans tous les cas, nous avons observe une Pa02 superieure à 9.31 kPa (70 torr) avec la perfusion de ketamine et une Fi02 de 1.0, de même qu’une élévation du shunt qui passait de 25.9 àa 36 pour cent en faisant passer la Fi02 de 0.5 à 1.0.
En conclusion, nous considérons la kétamine comme une bonne alternative aux anesthésiques volatils au cours d’anesthésie à un seul poumon chez les patients susceptibles de mal tolérer un certain degre d’hypoxémie en cours de chirurgie.
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Weinreich, A.I., Silvay, G. & Lumb, P.D. Continuous ketamine infusion for one- lung anaesthesia. Canad. Anaesth. Soc. J. 27, 485–490 (1980). https://doi.org/10.1007/BF03007049
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DOI: https://doi.org/10.1007/BF03007049