Background: One-lung ventilation during thoracic surgery frequently disturbs normal systemic oxygenation. However,\nthe effect of anesthetics on arterial oxygenation during one-lung ventilation has not been well established in human\nstudy. In this clinical trial, we investigated whether a difference between desflurane-remifentanil and propofol-remifentanil\nanesthesia can be observed with regard to oxygenation during one-lung ventilation for thoracoscopic surgery.\nMethods: Adult patients with lung cancer, scheduled for video-assisted thoracoscopic lobectomy without preoperative\noxygen support, were screened and randomized to receive desflurane or propofol, with remifentanil continuous infusion\nin both groups. Mechanical ventilation was performed with tidal volume of 8 ml/kg and FIO2 0.5 during two-lung\nventilation, and 6 ml/kg and 1.0 during one-lung ventilation, both with positive end-expiratory pressure of 5 cmH2O.\nArterial blood gas analysis was performed preoperatively, during two-lung ventilation, and after 15, 30, 45, and 60 min of\none-lung ventilation. The primary endpoint was PaO2 at 30 min after initiating one-lung ventilation. Statistical analyses\nincluded the independent t-test for the primary endpoint and a mixed model with a post-hoc analysis to evaluate the\nserial changes in values.\nResults: Patients were recruited between July 9 and December 2, 2014. In total, 103 patients were analyzed (n = 52 in\ndesflurane group and n = 51 in propofol group). The primary endpoint, PaO2 at 30 min of one-lung ventilation was lower\nin the desflurane group than the propofol group (170 Ã?± 72 vs. 202 Ã?± 82 mmHg; p = 0.039). Serial changes in PaO2 during\none-lung ventilation showed lower levels during desflurane anesthesia compared with propofol anesthesia (mean\ndifference, 45 mmHg; 95% confidence interval, 16ââ?¬â??75 mmHg; p= 0.003).\nConclusions: In conclusion, desflurane-remifentanil anesthesia resulted in decreased arterial oxygenation compared with\nthat of propofol-remifentanil anesthesia during one-lung ventilation for thoracoscopic surgery in patients with lung\ncancer.
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