| Objective:To evaluate the effects of endobronchial blocker intubation on hyoxemia in patients undergoing gastric cardiac carcinoma resection when compared with double-lumen endobronchial intubation.Methods:One hundred and eighty patients?age range,4064 year;male or female;body mass index,18.524;ASA physical status I or II?undergoing elective gastric cardiac carcinoma resection were enrolled.Patients were assigned randomly into two groups?n=90?:A.endobronchial blocker group?Group BB?:patients in this group were intubated with a 7.5mm internal diameter standard single-lumen endotracheal tube,and BT was then achieved with a 9 French bronchial blocker.B.double-lumen bronchial tube group?Group DLT?:patients in this group with the right-sided double-lumen tracheal tube.Patients were monitored routinely with electrocardiograph?ECG?,heart rate?HR?,saturation of pulse oximetry?SpO2?,end-tidal CO2(PETCO2),invasive artery blood pressure?ABP?,central venous pressure?CVP?and body temperature.Anesthesia was induced by 0.20.4?g/kg sufentanil,0.20.3mg/kg etomidate and 0.2mg/kg cisatracurium intravenously.Three minutes later,the BB or DLT was placed by the same senior thoracic anesthesiologist who was familiar with these devices before the study following the allocated number which the patient got.All the patients were performed with fiberoptic brochoscope?FOB?to confirm correct positioning of the tube.The patients were ventilated with Datex-Ohmeda Aestive/5 7100,with a Fi O2 of 0.8,ventilator settings were adjusted to a VT of 810 ml/kg,rate of 12 min-1 and I?E ratio 1?2,with a Fi O2 of 1.0 during one lung ventilation,while a VT of 67 ml/kg,rate of 15 min-1 and I?E ratio 1?2during one lung ventilation to maintain normal PETCO2.Anesthesia was maintained with inhaled 1.7%3%sevoflurane,0.10.2?g/kg/min remifentanil and cisatracurium administered intravenously to maintain BIS 4060.If SpO2 was lower than 90%during one lung ventilation,FOB was performed again to identify the transposition of the BT or the DLT;the occurrence of transposition was recorded.As for the patients without transposition,35cmH2O of CPAP was performed.For those patients with low SpO2,two lung ventilation was then performed.Sodium acetate solution and hydroxyethyl strarch 130/0.4 were administered intravenously at the speed of710ml/kg/h to maintain the urinary output being not less than 1ml/kg/h.When the operation procedure was over,and the patient was with good spontaneous breathing to maintain Sp O2>95%and consciousness again,the intubation was removed.Times for variables recording:T0:before the anesthesia inductionT1:10 minutes after one lung ventilationT2:20 minutes after one lung ventilationT3:30 minutes after one lung ventilationThe demographic data were recorded.The primary endpoint was the transposition time when hyoxemia was occurred and Ppeak increased,and MAP,HR,SpO2 and Ppeak were recorded the time mentioned above.The minor endpoint were the tracheal intubation time,one lung ventilation time,surgery time,urinary output and volume of fluid.The number of patients who had discontinued surgical procedures due to poor lateral lung collapse during one-lung ventilation was recorded.Results:There were three patients in Group DLT dropped out?for massive hemorrhage?.1.The two groups were comparable in terms of age,weight,male/female ratio,procedure duration,OLV duration,volume of fluid and urinary output during the study and there was no significant difference?P>0.05?.In both groups,there was no case in which surgery was discontinued due to poor lung collapse during one-lung ventilation.2.Compared with Group DLT,MAP,HR at T0,T1,T2 and T3 in Group BB had no statistically difference?P>0.05?.3.Compared with Group DLT,constituent ratio at T0 in Group BB was larger as for the section of Ppeak?14cmH2O?P<0.05?,while it was smaller as for the section of Ppeak>24cmH2O?P<0.05?.There was no statistically difference in constituent ratio between two group as for the section of14cmH2O<Ppeak?24cmH2O?P>0.05?.4.Compared with Group DLT,constituent ratio at T0 in Group BB was smaller as for the section of SpO2<90%?P<0.05?,while it was also smaller as for the section of 90%?SpO2<95%?P<0.05?.It was smaller statistically in constituent ratio in Group BB when compared with Group DLT as for the section of SpO2?95%?P<0.05?.5.The transpositions times in Group BB decreased significantly compared with Group DLT?P<0.05?.Conclusions:Compared with right-sided double-lumen tracheal tube,patients with endotranchial blocker have better constituent ratios of hypoxia,lower constituent ratios of Ppeak?14cmH2O and less transposition times and lower transposition ratio.So the endotranchial blocker can improve the lung oxygenation better for the patients undergoing gastric cardiac carcinoma resection and may be better useful. |
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