One-Lung Ventilation
Conditions
Keywords
Isoflurane, Sevoflurane, Bispectral Index, Pulmonary Surgical Procedures
Brief summary
The aims of the study is to determine if end-tidal concentrations of the anaesthetic gases isoflurane and sevoflurane as measured by a standard gas monitor are related to the blood levels during one-lung ventilation.
Detailed description
Measurement of the anaesthetic gases such as isoflurane and sevoflurane allow anaesthetists to gauge their blood levels and in turn their brain levels and so help assess how deep the patient is under anaesthesia. These measurements, made as the patient breathes out, are known as end-tidal concentrations of anesthetic gases and are routinely made with gas monitors. Measurement of blood levels of anaesthetic gases is possible but infrequently done as it is time-consuming, expensive, and requires a scientist in a laboratory with specialized equipment. Depth of anaesthesia is assessed using clinical signs along with end-tidal concentrations though more recently it can be assessed by monitoring the brain's electrical waves. This technique remains controversial. Mechanically supporting the patient's breathing using only one of the two lungs, known as one-lung ventilation, is used in lung surgery to allow the surgeon to gain access to one side of the chest whilst the anaesthetist supports the lung on the other side. One-lung ventilation markedly alters the exchange of gases in the lungs, including anaesthetic gases. Because of this derangement, it is not known if the end-tidal concentrations are related to blood levels of anaesthetic gases during this type of mechanical ventilation. The aims of the study is to determine if end-tidal concentrations of anaesthetics as measured by a standard gas monitor are related to the blood levels of the gases isoflurane and sevoflurane during one-lung ventilation. Patients over 18 years old undergoing planned lung surgery with one-lung ventilation and anaesthesia with isoflurane or sevoflurane, and who have a routine tube inserted into an artery in their wrist to monitor blood pressure will be recruited for the study. During the study, two blood samples the size of two teaspoons each will be taken from the tube in the artery and two end-tidal concentration recordings.
Interventions
PROCEDURELung Surgery with One-Lung Ventilation
A single cohort of patients undergoing one-lung ventilation during lung surgery
Sponsors
NHS Lothian
University of Edinburgh
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Over the age of 18 * Admitted for elective thoracic surgery using one-lung ventilation obtained by the use of a double-lumen endotracheal tube or bronchial blocker. * Elective surgery planned between 1 August and 30 November 2016 * Planned insertion of an arterial cannula by anaesthetist for routine monitoring of systemic arterial pressure * Planned inhalational anaesthesia technique with isoflurane or sevoflurane. * Patients who have provided consent to take part in the study
Exclusion criteria
* Patients under the age of 18 * History of malignant hyperthermia * Emergency thoracic surgery * Patients who have not consented to take part in the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Correlation Between Blood and End-tidal Isoflurane or Sevoflurane Concentration During One-lung Ventilation | 10 minutes after start of one-lung ventilation | The significance of the correlation between blood and end-tidal isoflurane or sevoflurane concentration during one-lung ventilation |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Correlation Between Bispectral Index (BIS) and End-tidal Isoflurane or Sevoflurane Concentration During One-lung Ventilation. | 10 minutes after start of one-lung ventilation | The significance of the correlation between BIS and end-tidal isoflurane or sevoflurane concentration during one-lung ventilation. |
Countries
United Kingdom
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Lung Surgery With One-Lung Ventilation A single cohort of patients undergoing one-lung ventilation during lung surgery
Lung Surgery with One-Lung Ventilation: A single cohort of patients undergoing one-lung ventilation during lung surgery | 19 |
| Total | 19 |
Baseline characteristics
| Characteristic | Lung Surgery With One-Lung Ventilation | — |
|---|---|---|
| Age, Continuous | 67.2 years STANDARD_DEVIATION 9.8 | — |
| Race and Ethnicity Not Collected | — | — Participants |
| Sex: Female, Male Female | 10 Participants | — |
| Sex: Female, Male Male | 9 Participants | — |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 0 / 19 |
| serious Total, serious adverse events | 0 / 19 |
Outcome results
Primary
Correlation Between Blood and End-tidal Isoflurane or Sevoflurane Concentration During One-lung Ventilation
The significance of the correlation between blood and end-tidal isoflurane or sevoflurane concentration during one-lung ventilation
Time frame: 10 minutes after start of one-lung ventilation
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Lung Surgery With One-Lung Ventilation | Correlation Between Blood and End-tidal Isoflurane or Sevoflurane Concentration During One-lung Ventilation | 0.0807 Correlation coefficient |
Secondary
Correlation Between Bispectral Index (BIS) and End-tidal Isoflurane or Sevoflurane Concentration During One-lung Ventilation.
The significance of the correlation between BIS and end-tidal isoflurane or sevoflurane concentration during one-lung ventilation.
Time frame: 10 minutes after start of one-lung ventilation
Population: Data not collected due to insufficient use of Bispectral Index Monitors and temperature monitors by anaesthetists responsible for the study participants at the study site.