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SuleymanDemirel University TIP FACULTY JOURNAL: December 2003; 10(4) In Toraks surgery the impact of cervical epidural anesthesia on the intrapulmonary shant rate of Uğur GÖKTAŞ, Leyla SHAHAN, Hilal SAZAK, Fatma ULUS, Rana SIRMALI, Mehmet SIRMALI, Eser SHAVKILIOĞLU Summary: In this study, elective pulmonary resection planned, in ASA I-II class cases, combined anesthesia (Torrical epidural anesthesia - general anesthesia combination) and general anesthesia; hemodynamics, oxigenization, pulmonary hemodynamics, intrapulant, arterial mixture and arterial mixture were compared to the general anesthesia. Method and means: Patients in the group of combined anesthesia (Group I) were given total intravenous anesthesia method along with cervical epidural anesthesia. The other group (II. Only total intravenous anesthesia was administered. Patients of the I. group were placed an epidural catheter from the range of T7- 8 / T8-9, 6-10 ml of 0.5 % bupivakain was expected to be sprayed for 20 minutes. In all cases, the induction was provided with 3 mg midazolam, 2 μg/kg fentanil, 2 mg/kg propofol, 0.2 mg/kg cisatrakurium. Anesthesia was provided in both groups with 9-6 mg/kg/h propofol and 0.05 mg/kg cisatrakurium. The first 20 minutes before diluted with the Propofol perfuser were continued at 9 mg/kg/h, then at 6 mg/kg/h. Arterial and mixed venous blood gas measurements of the groups were studied. Intrapulmonary shant rates have been calculated. Hemodynamic parameters have been recorded. The average pulmonary arterial pressure, pulmonary capillary wedge pressure, central venous pressure; double lung ventilation in 20 minutes, single lung ventilation in 20. Minutes and the end of the surgery were recorded. Results: I. group systolic / diastolic / average arterial blood pressure; pre-induction, entubation, double lungs venti- lasion 20 minutes, single lungs ventilation 20 minutes measurement values II. It was found lower compared to the group (p<0,05). Between the groups; there was no significant difference in terms of heart rate, average pulmonary arterial pressure, pulmonary capillary wedge pressure and central venous pressure. Although the intrapulmonary shant values were higher in group I, there was no significant difference between the groups (p>0,05). In both groups, the height of the end of the surgery was significant compared to the 20 minutes of double lung ventilation of the intrapulmonary values (p<0,05). The result: the application of combined anesthesia can be preferred because of providing more stable hemodynamics in patients, reducing the need for anesthetic medications, and better suppressing the surgical stress. Although the intrapulmonary shant rate is higher in the group of combined anesthesia, we believe that this situation does not prevent the use of combined anesthesia in breast surgery. Keywords: toracular epidural anesthesia, toracular surgery, intrapulmonary shant. Abstract Influence of thoracic epidural anesthesia on intrapulmonary shunt fraction in thoracic surgery Background: In this study, influence of combined anesthesia (thoracic epidural anesthesia - combined with general anesthesia- sia) and general anesthesia on hemodynamia, oxygenation, pulmonary arterial hemodynamia, intrapulmonary shunt, arterial blood gas and mixed venous O2 pressure were compared in cases of ASA physical status I-II that planned for elec-tive pulmonary resection. Methods: Thoracic epidural anesthesia and total intravenous anesthesia methods were applied together to the patients in group of combined anesthesia (Group I). Only total intravenous anesthesia was applied to other group (Group II). In patients of Group I an epidural catheter was applied T7-8 or T8-9 interspinal space and waited for 20 minutes after 6-10 mL of 0.5% bupivacaine bolus injection. In all cases, induction is obtained with midazolam 3 mg, fentanyl 2 μg.kg-1, propofol 2 mg.kg- 1, cisatracurim 0,2 mg.kg-1. Anesthesia maintenance was obtained with propofol 9-6 mg.kg-1.h-1 and cisatracurim 0.05 mg.kg-1 in both of the groups. Propofol was applied with perfusor without dilution in doses of 9 mg.kg-1 for the first 20 minutes and then continued in doses of 6 mg.kg-1. Arterial and mix venous blood gases measurements of groups were obtained. Intrapulmonary shunt fractions were calculated. Haemodynamic parameters were recorded. Mean pulmonary arterial pressure, pulmonary capillary wedge pressure and central venous pressure were noted at the 20th minute of two-pneumal ventilation, at the 20th minute of one-pneumal ventilation and at the end of surgery. Results: The first group sistolic / diastolic / average arterial blood pressure before the induction, during the intubation, at the 20th minute of two-lung ventilation and at the 20th minute one-lung ventilation were lower than the second group (p<0,05). Any meaningful differences of heart rate, average pulmonary arterial pressure, pulmonary capillary wedge pressure and cen-tral venous pressure between the groups could not be found. Although the intrapulmonary shunt values of Group I were higher, there were no meaningful difference (p>0,05). The height of intrapulmonary shunt values at the end of surgery in comparison to value at the 20th minute of two-lung ventilation were meaningful (p<0,05). Conclusion: Combined anesthesia procedure can be preferred because it obtains stable hemodynamia, decreases anesthesic drug need and depress the surgical stress better. Although the intrapulmonary shunt fraction is higher in the group of com-built anesthesia, this situation does not prevent the use of combined anesthesia in thoracic surgery. Keywords: thoracic epidural anesthesia, thoracic surgery, intrapulmonary shunt.