Nebulized dexmedetomidine improves pulmonary shunt and lung mechanics during one-lung ventilation: a randomized clinical controlled trial

作者：Bo Xu, Hong Gao, Dan Li, Chunxiao Hu, Jianping Yang · 发表于：PeerJ · 年份：2020 · DOI：10.7717/peerj.9247 · 被引用次数：21 · 研究领域：Anesthesia and Sedative Agents、Respiratory Support and Mechanisms、Airway Management and Intubation Techniques

Background Dexmedetomidine (Dex), a selective a 2 -adrenergic receptor agonist, has been previously reported to attenuate intrapulmonary shunt during one-lung ventilation (OLV) and to alleviate bronchoconstriction. However, the therapeutic effects of nebulized Dex on pulmonary shunt and lung mechanics during OLV have not been evaluated. Here we determine whether nebulized dexmedetomidine improved pulmonary shunt and lung mechanics in patients undergoing elective thoracic surgery in a prospective randomized controlled clinical trial. Methods One hundred and twenty-eight patients undergoing elective thoracoscopic surgery were included in this study and randomly divided into four groups: 0.9% saline (Placebo group), 0.5 µg/kg (Dex 0.5 group), 1 µg/kg (Dex 1 group) and 2 µg/kg (Dex 2 group) dexmedetomidine. After bronchial intubation, patients received different nebulized doses of dexmedetomidine (0.5 µg/kg, 1 µg/kg and 2 µg/kg) or 0.9% saline placebo during two-lung ventilation(TLV). OLV was initiated 15 min after bronchial intubation. Anesthesia was maintained with intravenous infusion of cisatracurium and propofol. Bispectral Index values were maintained within 40–50 by adjusting the infusion of propofol in all groups. Arterial blood gas samples and central venous blood gas samples were taken as follows: 15 min after bronchial intubation during two-lung ventilation (TLV 15 ), after 30 and 60 min of OLV (OLV 30 and OLV 60 , respectively) and 15 min after reinstitution of TLV (R...