• Mark Yew-Hoong Chow, Meng-Huat Goh, Sek Koon Boey, Agasthian Thirugnanam, and Pierre Christian Ip-Yam.
• Department of Anaesthesia and Surgical Intensive Care Unit, Singapore General Hospital, Singapore. markchow@bigfoot.com
• J. Cardiothorac. Vasc. Anesth. 2003 Feb 1;17(1):69-72.

ObjectiveTo compare the effects of remifentanil and thoracic epidural analgesia on the hemodynamic changes and pulmonary shunt fraction during one-lung ventilation (OLV) for thoracotomy.DesignProspective, single crossover design.SettingTertiary care hospital.ParticipantsThirty-four patients undergoing OLV for thoracic surgery.InterventionsDuring general anesthesia with 2-lung ventilation, one-lung ventilation with remifentanil infusion, and one-lung ventilation with thoracic epidural anesthesia (TEA), hemodynamic parameters and arterial and mixed venous blood gases were taken from the radial and pulmonary artery catheters. During these 3 study periods, cardiac index (CI) was measured using thermodilution technique while shunt fraction (Qs/Qt), alveolar arterial oxygen gradient (A-a O(2)), and systemic (SVRI) and pulmonary vascular resistances indices (PVRI) were calculated. A p value <0.05 was taken to be statistically significant.Measurements And Main ResultsWhen OLV was instituted, there was a significant decrease in mean arterial blood pressure. Arterial oxygenation decreased, whereas CI and Qs/Qt increased during OLV, but there was no significant difference between remifentanil infusion and thoracic epidural analgesia.ConclusionsBoth remifentanil infusion and TEA are suitable for analgesia during thoracic surgery when OLV is used. There was no significant difference in PaO(2) and Qs/Qt during each administration.Copyright 2003, Elsevier Science (USA). All rights reserved.

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