Effect of protective reinflation in elderly patients with hypertension undergoing radical esophagectomy

CHEN Jun-yong; YE Jing; GUO Na; CAI Kai-can; QIN Zai-sheng

Abstract：Objective To observe the effect of protective reinflation on hemodynamic variables in elderly patients with hypertension undergoing radical esophagectomy.Methods 30 elderly patients scheduled for left -sided radical esophagectomy were allocated randomly to two groups:Group C or Group P ( n=15 each) .Anesthesia was induced and maintained with propofol by target controlled infusion, a right-sided double-lumen endobronchial tube was placed for one lung ventilation (OLV).Mean arterial blood pressure (MAP), cardiac output(CO), stroke volume (SV), stroke volume variation( SVV) and cardiac index( CI) were recorded by Vigileo-FloTrac system.Goal-directed fluid therapy was based on SVV, CI and MAP.Ventilation mode was switched to two lung ventilation ( TLV) before closure of the pleu-ra, when manual reinflation of the left lung within 5 s at a peak inspiratory airway pressure ( Ppeak) of 20 cmH2 O and a pause of 3 s in Group C.In Group P, 5 episodes of mechanical ventilation with a tidal volume of 10 mL/kg and a respira-tory rate of 12 bpm was performed before manual reinflation of the left lung with the same measure as in Group C.The var-iables recorded were CO, SV, CI, and SVV before and 1 min to 10 min after TLV ( TLV 1-10 min) .MAP, heart rate ( HR) , Ppeak and central venous pressure ( CVP) after 10 episodes of manual reinflation in Group C, and data of 5 epi-sodes of mechanical ventilation and 5 episodes of manual reinflation in Group P were also recoreded.Results The groups were comparable with regard to arterial blood gas analysis, HR and SVV during OLV.Time required to complete reinfla-tion of the left lung was longer in Group P.MAP in Group P was higher than in Group C and Ppeak, CVP in Group P was lower than in Group C in 5 episodes of mechanical ventilation after TLV.CO, SV and CI of Group P was higher than Group C from TLV 1 min to TLV 4 min.In Group C, CO, SV and CI from TLV 1 min to TLV 4 min and MAP after each episode of reinflation were lower than those before TLV.Significant trends were found toward a lower level of pro-brain natriuretic peptide and a higher level of PaO2 , as well as higher PaO2/FiO2 -ratio in Group P compared with those of Group C in the first postoperative day (P<0.05 or <0.01).Conclusion Manual reinflation following the mechanical ventilatory strategy provides a stable hemodynamic during surgery and a better postoperative oxygenation for elderly patients with hypertension.