Cardiopulmonary Function In Thoracolaparoscopic Oesophagectomy: Endobronchial Anesthesia VS Endotracheal Anesthesia With Intrathoracic CO₂ Insufflation

Objective To compare hemodynamic and respiratory changes during one-lung ventilation?OLV? using a double-lumen tube?DLT? or double-lung ventilation?DLV? using a single-lumen tube?SLT? with intrathoracic CO₂ insufflation in patient undergoing thoracolaparoscopic oesophagectomy.Methods Forty-five patients?29 men and 16 women? undergoing thoracolaparoscopic oesophagectomy, excluding heart function grade III-IV and lung diseases not endure long time single lung ventilation, were allocated to two groups: group D?20 patients; age, 60±10 years? in whom double-lung ventilation?DLV? were used by single-lumen tube?SLT?, and group O?25 patients;age, 61±8 years? in whom one-lung ventilation?OLV? by double-lumen tube?DLT?with intrathoracic CO₂ insufflation at a rate of 10–12L/min and sustained intrathoracic pressure at a 6-8mm Hg insufflation were used. Anesthesia and ventilation was standardized. Arterial blood gases were measured in all patients in left-lateral position with total lung ventilation?TLV? 10min?T1?; and 10 min?T2?, 30min?T3?, 60 min?T4?, 90 min?T5? after CO₂ insufflation in group D or OLV in group O; and in supine position with TLV 10min?T6?. Meanwhile, the following parameters were obtained:?1? Pulmonary oxygenation and related parameters:pulse oxygen saturation?SpO₂?, arterial oxygen saturation?SaO₂?, pressure of arterial oxygen?PaO₂?, oxygenation index?OI?, alveolar-arterial O₂ tension gradient?A-aDO₂?, respiratory index?RI?, PH and BE.?2? Hemodynamic parameters: heart rate?HR? and mean arterial pressure?MAP?.?3? respiratory mechanic parameters: peak airway pressure?Ppeak?, plate airway pressure?Pplat?,mean airway pressure?Pmean? and total respiratory dynamic compliance?Cdyn?.?4?CO₂ related parameters: pressure of arterial carbon dioxide?PaCO₂?, pressure of end-tidal carbon dioxide?PetCO₂? and arterial to end-tidal CO₂ gradient?Pa-etCO₂?Results1.There were no significant differences in patient characteristics, anesthesia and operation parameters between the two groups, except for the times required for intubation were significantly shorter in the group D than group O?P<0.05?.2.Compared with T1, both groups during the operation?T2-5?HR, Ppeak, Pplat, Pmean,PaCO₂, PetCO₂, Pa-etCO₂, A-aDO₂, RI were significantly increase and SpO₂, SaO₂,PaO₂, OI, PH, BE were significantly decrease?P<0.05?, after the thoracic operation?T6? all had recovered except for Pplat, Cdyn, Pa-etCO₂, PH, BE and Ppeak in group O and PetCO₂ in group D.3.Compared with group O: Before the operation?T1?: Ppeak, Pplat were slightly lower in group D?P=0.029, P=0.042 respectively?. After the thoracic operation?T6?: HR was faster and Cdyn was better in group D?P<0.05?. During the operation?T2-5?:MAP, Ppeak, Pplat, Pmean, Cdyn were no difference in statistics between the two groups,however, HR was obvious faster, PaCO₂, Pa-etCO₂, SaO₂, PaO₂, OI were distinctly higher and A-aDO₂, RI, PH, BE were apparently lower in group D?P<0.05?.Conclusion1.DLV with intrathoracic CO₂ insufflation is a feasible and safe airway management during thoracolaparoscopic oesophagectomy, however, attention should be paid to the treatment of hyperlipidemia.2.General anesthesia with DLV with intrathoracic CO₂ insufflation provides the same perfect hemodynamic stability but better oxygenation, shorter intubation times compares to general anesthesia with OLV.