Effect Of Preoperative Budesonide Inhalation On Arterial Oxygenation And Intrapulmonary Shunt During One-lung Ventilation

Objective Toobserve the effect of preoperative budesonide inhalation on arterial blood oxygenation and intrapulmonary shunt during one-lung ventilation and explore the effect of budesonide inhalation on lung protection during one-lung ventilation.Methods Fifty ASAⅠor Ⅱ patients,aged 45-65 yr,weighing 45-75 kg,with body height155-176 cm,undergoingvideo-assistthoracoscopic lobectomy wererandomly divided into group budesonide（Group B）and group control（Group S）,25 cases each.ECG,BP,Sp O₂ were regularly monitored.20 gauge cannula needle for radial artery catheterization underlocal anesthesia,monitoring ABP.The right subclavianvein was selected for catheterization under local anesthesia.Before induction of anesthesia,inhaling budesonide 2mg/4ml 15 min in Group B or inhaling NS 4ml 15 min in Group S.Anaesthesia was induced after inhalation with sufentanil（0.4μg/kg）,propofol（2mg/kg）,rocuronium（1mg/kg）.Double-lumen endobronchial tube（DLT）was inserted with fr 37 for male,35 for female.The position was confirmed by fibreoptic bronchoscope.After positioning the patient in lateral decubitus,the correct position of the double-lumen tube was rechecked by fibreoptic bronchoscope.Anesthesia was maintained with continuous infusions of propofol at 3-8mg/（kg·h）andremifentanil at 0.1-0.2μg/（kg·min）,sevoflurane at 1-1.5vol% and intermittent Rocuroniumat0.2mg/kg.Ventilatory settings were identical during two-lung ventilation:8-10ml/kg tidalvolume,10-12/minventilatory rate,volume controlmode,inspiratoryto expiratoryratio 1:2,and Fi O₂100%.Setting for One-lung ventilation:5-7ml/kgtidalvolume,12-14/min ventilatory rate,volumecontrol mode,inspiratory to expiratory ratio 1:2,and FiO₂ 100%.HR,MAP,Pmean,Cdynand Pa O₂ weredeterminedat times of beforeinhalation（T₀）,before OLV（T₁）,10min（T2）,30min（T₃）,and60min（T₄）after OLVand10 minaftertheend OLV（T₅）.Blood samples were takenfrom subclavian vein and radial artery for blood gas analysis in all patients.Results 1.There were no significant differences in patient characteristics,pulmonary function,preoperative Pa O₂ andoperation parameters between the two groups（P>0.05）.2.No significant differences were found in MAP,HR between the two groups in the T₁^T₅（P>0.05）.3.The levels of Pmean and Cdyn（1）Comparison between groups No significant differences were found in Pmean and Cdyn at T₁^T₄ between two groups（P>0.05）.Cdyn at T₅ in group Bwas higher than that in group S（P<0.05）.No significant differences were found in Pmeanat T₅ between two groups（P>0.05）.（2）Comparison within groups Pmean at T2^T₄in two groups were higher,Cdyn at T2^T₄intwo groups were lower compared to those at T₁（P<0.05）.Pmean and Cdynat T₁ and T₅ were nodifferent in two groups（P>0.05）.4.The levels of Pa O₂ and Qs/Qt（1）Comparison between groups Pa O₂ and Qs/Qt at T₁^T₃were not significant between two groups（P>0.05）.Pa O₂ at T₄^T₅in group Bwas higher than that in group S（P<0.05）,while Qs/Qtat T₄^T₅in group B was lower than that in group S（P <0.05）.（2）Comparison within groups In both groups Pa O₂ at T2^T₄ was lowerthan that at T₁（P<0.05）,while Qs/Qtat T2^T₄ was higherthan that at T₁（P<0.05）.Pa O₂ and Qs/Qt at T₅ were no differentin group B comparedwith those at T₁（P>0.05）.Pa O₂ was lower at T₅ than that at T₁ in group S（P<0.05）,Qs/Qt was higher at T₅ than that at T₁ in group S（P<0.05）.Conclusion preoperative budesonide inhalation may improve arterial blood oxygenation and reduce intrapulmonary shunt in patients undergoing video-assist thoracoscopic lobectomy during one-lung ventilation.