Effects of volatile versus intravenous anesthesia on oxygenation and hemodynamic response during thoracotomy with one-lung ventilation

Background
The aim of this study was to evaluate the effects of total intravenous anesthesia by propofol and ketamine (ketofol) versus that of inhalational anesthetic technique using sevoflurane on oxygenation and hemodynamics before, during, and after one-lung ventilation (OLV) in adults undergoing thoracic surgery.
Patients and methods
Twenty-eight patients (American Society of Anesthesiologists) II–III were undergoing thoracic surgery requiring OLV. Each patient was randomly allocated to one of two groups: ketofol group, in which induction was performed with 1% propofol 1.5–2.5 mg/kg, with ketamine 1 mg/kg and, in the second group (sevoflurane), 8% sevoflurane. Fentanyl 2 μg/kg and cisatracurium 0.1 mg/kg was administered to both groups. Anesthesia was maintained with ketamine and propofol in the ketofol group and 2% sevoflurane in the sevoflurane group.
Results
Arterial blood gas analysis, end-tidal carbon dioxide concentration, heart rate, mean arterial pressure, and end-tidal concentration of sevoflurane were noted in the sevoflurane group. In patients receiving ketofol, fentanyl requirements were decreased when compared with the sevoflurane group. However, the total dose of phenylephrine was greater in patients receiving sevofluran when compared with those receiving ketofol (5 µg/kg/patient vs. 1.1 µg/kg/patient). Mean arterial pressure was reduced during the course of OLV in both groups, as compared with levels found before OLV (<0.05). Sevoflurane anesthesia induced a significant reduction in heart rate, whereas no significant difference in heart rate was found in the ketofol group. Initiation of OLV caused a significant decrease in PaO and SpO in both groups, especially in the sevoflurane group, as compared with the ketofol group.
Conclusions
The combination of ketamine and propofol anesthesia has a relatively mild influence on hypoxic pulmonary vasoconstriction and more hemodynamic stability compared with conventional inhalational anesthetics with sevoflurane for OLV anesthesia.