72 Respiration
5AP1-9 n=10 and desflurane group n=10). All patients were intubated after intravenous
Fentanyl from the exhaled breath may contribute to the
occupational exposure
E. Li, H. Wang, C. Wang, Y. Gong, Y. He
Anesthesiology, Harbin Medical University, Harbin, Heilongjiang, China
Background and Goal of Study: Opiate narcotics, such as fentanyl, adminis-
tered intravenously to patients may be breathed out to be a source of exposure
which may contribute to an increasing opiate abuse among the anesthesiolo-
gists. The aim of this study was to monitor fentanyl in the expired air of the
patients.
Materials and Methods: Three patients undergoing cardiac surgery with car-
diopulmonary bypass were involved. After fentanyl was administered, the air
samples were collected from the expiratory circuit of the anesthesia machine
prepared by solid-phase microextraction and analyzed by gas chromatography-
mass spectrometry (GC/MS). Preliminary works were carried out using the
GC/MS in the full scan mode to check the retention time of fentanyl, then the
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GC/MS was operated in the SIM mode to enhance the sensitivity and the se-
lected m/z were 245,189 and 146. The air samples were monitored in both the
SIM mode and the full scan mode.
Results and Discussion: Fentanyl was detected in the expired breath of pa-
tients in both the SIM mode and the full scan mode. The chromatograms are
shown in Figures 1 and 2.
Figure 1. Chromatogram obtained at SIM mode.
Figure 2. Chromatogram obtained at full-scan mode.
Anesthetics contribute to the arising health hazards among the anesthesiolo-
gists. Investigation showed an increasing number of anesthesiologist addicts.
Fentanyl may induce the addiction if it can pass the pulmonary blood-gas bar-
rier and be exhaled after intravenously administering. GC/MS is a highly sensitive
analytical method and SPME is an effective sampling and sample preparation
technique. In this study, they were applied to analyze fentanyl in the expired air.
Conclusion(s): Fentanyl in the expired air of the patients under anesthesia may
contribute to the occupational exposure and explain the high rate of addiction
to anesthesiologists.
5AP1-10
Effect of two different MAC concentrations of desflurane and
sevoflurane on pulmonary resistance during anesthesia
V. Nyktari, A. Papaioannou, A. Lappa, N. Volakakis, H. Askitopoulou
Anesthesiology, University Hospital, Heraklion, Crete, Greece
Background and Goal of Study: Among the anaesthetic drugs, volatile agents
possess bronchoactive properties. There is consensus in the literature that
isoflurane and sevoflurane are at least as potent bronchodilators as halothane.In
contrast, the data on desflurane are conflicting.This study examined the effect
of two different concentrations of desflurane and sevoflurane on total pulmonary
resistance (Rpulm ) in patients with normal lung function.
Materials and Methods: 20 patients undergoing total knee replacement were
divided in two groups in regard to the volatile agent used (sevoflurane group
induction to anaesthesia and ventilated with volume control mode. A pneumo-
tachograph and a pressure transducer were inserted between the tracheal tube
and the Y piece of the respiratory circuit, for the measurements of flow, tidal vol-
ume and inspiratory pressures. Maintenance of anaesthesia was achieved with
desflurane or sevoflurane as follows: 1 MAC of the volatile was administered for
30 minutes and the aforementioned parameters were recorded every 5 minutes.
Then the volatile was turned off and measurements were recorded at 0.5 and 0
MAC (at 34 and 41 minutes respectively). The same was performed at 1.5 MAC
in both groups.Rpulm was calculated at 1 and 1.5 MAC for each patient.
Results and Discussion: Sevoflurane at 1 MAC concentration produced a de-
crease in Rpulm only at 34 minutes (p<0.05) and 41 minutes (p<0.001) whereas
at 1.5 MAC there was no significant change in Rpulm at any time. When1.5 MAC
was compared to 1 MAC, there was no difference in Rpulm . Desflurane admin-
istration for thirty minutes exhibited a biphasic response. Initially there was a
significant increase in Rpulm (0, 5 and 10 min of administration, p<0.001) fol-
lowed by a decrease from baseline (25 and 30 min p<0.001). This effect was
present and at 1.5 MAC concentration. There was no difference in Rpulm when
comparing 1 to 1.5 MAC of desflurane. Finally the comparison of sevoflurane
with desflurane showed no significant difference in Rpulm in both 1.0 and 1.5
MAC concentrations.
Conclusion(s): Sevoflurane and desflurane administration at 1 and 1.5 MAC
concentrations did not demonstrate any significant difference in Rpulm . Desflu-
rane administration over time manifested an initial increase in Rpulm that could
be explained by its physical properties followed by a decrease explained by a
bronchodilatory action. Any differences from baseline Rpulm were marginal and
could not imply a clinical significance.
5AP2-1
UNIBLOCKER™ bronchial blocker tube facilitate rapid
one-lung ventiration by expert laryngoscopists during
video-assisted thoracoscopic surgery
T. Iizuka, M. Tanno, A. Notoya, S. Nakahara
Anesthesia, National Cancer Center Hospital, Chuo, Tokyo, Japan
Background and Goal of Study: In this study, we evaluated the efficacy of
a wire-guided bronchial blocker, UNIBLOCKER™ (Fuji Systems Corporation,
Tokyo, Japan) for achieving one-lung ventiration (OLV) during a video-assisted
thoracoscopic surgery (VATS).
Materials and Methods: 20 patients undergoing a VATS approach with the
new device, a bronchial blocker tube, UNIBLOCKER™ to establish OLV by ex-
pert laryngoscopists were studied. The time to place the UNIBLOCKER™ to the
right or the left mainstem bronchus, the quality of lung deflation was rated by
the surgeon under direct visualization as excellent, good, fair, or poor.
Results and Discussion: In all 20 patients, placement of the UNIBLOCKER™
was easily with fiberoptic aided technique. Speed of insertion increasing as ex-
perience improved. One-lung ventilation was well tolerated in all. The quality of
lung deflation was judged as being excellent or good in all patients, and the
surgical field was excellent in all cases. Data (mean±SD) are shown in the table:
Right VATS Left VATS
N 13 7
Time (sec) 43.7±11.6 34.7±9.3
Lung deflation excellent 5/15 excellent 5/7
good 8/13 good 2/7
Conclusion(s): For the expert laryngoscopist, to place the UNIBLOCKER™
was performed easy and quickly. Lung isolation was both safe and very effec-
tive in VATS. Advantages of placing a UNIBLOCKER™ include complete lung
separation, ability to deflate/inflate a lung on the operative side, easy and rapid
insertion and cost. Disadvantages include potential for blocker dislodgement
during surgical manipulation and inability to suction lung independently. In this
study, UNIBLOCKER™ showed ease to placement to the left mainbronchus,
and a better quality of lung collapse showed left > right. The development and
clinical use of UNIBLOCKER™ proved to be effective and easy to use for es-
tablishing OLV.
5AP2-2
Recent acute respiratory tract infection in adults is a
significant risk factor of postoperative complications
J. Canet, J. Sanchis, Z. Briones, G. Paluzié, S. Sabaté
Anaesthesiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
Background and Goal of Study: We hypothesised that a recent acute up-
per respiratory tract infection (URI) in adults before surgery could be a signifi-

cant risk factor for developing postoperative complications. Within a large study
looking for risk of perioperative complications in Catalonia (ARISCAT) we inves-
tigated the relationship between URI prior to surgery and postoperative compli-
cations.
Materials and Methods: A prospective multicentre cohort study was per-
formed in 59 hospitals in 2006. We collected pre, intra and postoperative in-
formation until 3 months postoperatively for patients aged 18 yr or older un-
dergoing inpatient surgery, excluding obstetrics, on a random sample taken on
7 different days in each hospital. Surgery was carried out under general, neu-
roaxial or plexus block anaesthesia. We asked if the patient had experienced
an URI with fever and requiring medical treatment in the month before surgery.
We compared qualitative variables with a χ2 test and quantitative variables with
a t test. Odds ratios (OR) and 95% confidence intervals were calculated for
postoperative complications.
Results and Discussion: Of 2,468 patients meeting inclusion criteria, 146
(5.9%) had an URI. The OR were 2.4 (1.6-3.5) for any postoperative complica-
tion, 4.9 (3.1-7.9) for respiratory complications, 2.4 (1.3-4.4) for cardiovascular
complications, and 2.5 (1.4-4.4) for wound complications. Postoperative length
of stay was longer (8.3 vs 5.7 days; P=0.025) and mortality at 3 months higher
(6.9 vs 2.2%; P=0.002) for patients who had had an URI.
Conclusion(s): Our study demonstrates that an URI in adults in the month be-
fore surgery is a significant risk factor for a wide variety of postoperative com-
plications. Our results suggest that URIs, through either local respiratory tract
effects or systemic ones, can have a negative impact on postoperative out-
come. The history of URI should be investigated preoperatively, and in patients
at higher risk of postoperative complications elective surgery should probably
be delayed.
Acknowledgements: Supported by Fundació La Marató de TV3 041610-
2003.
5AP2-3
Diaphragmatic function after liver lobectomy: A sonographic
study
S. Koh, S. Kim, S. Na
Anesthesiology and Pain Medicine, Yonsei University Health System, Seoul,
Republic of Korea
Background and Goal of Study: Ultrasonography has been used as a means
of assessing hemidiaphragmatic movement and it is now generally accepted to
be a sensitive and reproducible method. In this prospective study, we evaluated
the postoperative impairment of diaphragmatic movement using ultrasonogra-
phy and compared with standard pulmonary function test (PFT) after liver lobec-
tomy.
Materials and Methods: We used M-mode sonography to measure diaphrag-
matic movement in 15 patients before and after liver lobectomy. Diaphragmatic
movements were assessed by ultrasonography after PFT before and 24 hours,
48 hours, and 7 days after operation. We measured the diaphragm inspiratory
amplitude (DIA, in cm), the diaphragm inspiratory/expiratory movement mean
velocity (DIV/DEV, in cm/s) during quiet, deep and sniff breathing.
Results and Discussion: Postoperative DIA of deep inspiration showed sig-
nificant reduction until 48hours. Seven days after operation, the DIA and PFT
progressively returned to the preoperative value. The changes of DIA correlated
with changes of functional vital capacity (r=0.581-0.704).
Sonographic measurement before and after liver lobectomy
Before surgery POD 1day POD 2day POD 7day
DIA (cm), quiet breathing 1.37±0.45 0.77±0.22* 0.96±0.27 1.17±0.34
DIA (cm), deep breathing 4.40±2.03 1.43±0.49*† 1.76±0.89*† 3.43±0.71
DIA (cm), sniff breating 1.56±0.36 1.14±0.38 1.00±0.25 1.16±0.32
FVC (liter) 3.30±0.88 1.46±0.44*† 1.45±0.56*† 2.19±0.57
Data are expressed as mean ± SD. DIA = quiet, deep, and sniff diaphragmatic inspiratory
amplitude, *P < 0.05 between before surgery and POD measurements. † P < 0.05 between
POD 7 days and POD measurements.
Conclusion(s): Using M-mode sonography technique, we were able to evalu-
ate diaphragmatic function successfully and found a significant decrease of the
DIA during immediate postoperative period with recovery until 7 days after liver
lobectomy.
References:
1 Ayoub J et al. Diaphragm movement before and after cholecystectomy: a sonographic
study. Anesth Analg 2001; 92: 755–61.
2 Frazee RC et al. Open versus laparoscopic cholecystectomy. A comparison of postopera-
tive pulmonary function. Ann Surg. 1991 Jun; 213: 651–3.
Respiration 73
5AP2-4
Does preoperative oral carbohydrate fluids administration
improve the perioperative period after major thoracic
surgery?
J. Tyczka, B. Tamowicz, P. Ciszewski, J. Nadolski, A. Mikstacki
Intensive Therapy Department, Pulmonary Disease and Thoracic Surgery
Center, Karol Marcinkowski University of Medical Sciences, Poznan,
Poland
Background and Goal of Study: Restrictive perioperative fluid management is
recommended in major thoracic surgery. In association with preoperative fast-
ing, it may result in dehydratation and metabolic disturbances. The aim of the
study was to compare patients discomfort, changes in the intraoperative blood
pressure after combined anesthesia with thoracic epidural analgesia, postop-
erative renal function, plasma glucose levels, gas exchange, PONV and other
early complications in patients who received carbohydrate drinks preoperatively
to the overnight fasted control group.
Materials and Methods: Thirty patients aged 58±8 yrs undergoing lung re-
section were enrolled. In group A 15pts were given to drink 1500mL of 8% car-
bohydrate drink 8 hours before the anesthesia. In group B 15pts were fasted
for 14 hours (evening and night), drinking water when required. Exclusion cri-
teria included diabetes mellitus, renal and heart failure. We assessed patients
discomfort using VAS scores for thirst, hunger, tiredness and inability to con-
centrate. Prior to the induction of anesthesia (fentanyl, propofol, rocuronium)
thoracic epidural analgesia (T5-6, 0.25% bupivacaine and fentanyl 100mcg)
was performed. Crystalloids and colloids up to 15mL· kg -1 were infused in-
traoperatively. Hypotension defined as decrease in blood pressure during anes-
thesia below 90 mmHg or of 30% from baseline and dose of ephedrine used
were evaluated. Fluid balance, urine output, creatinine clearance and excretion,
PaO2, plasma glucose, electrolytes and urea levels were measured on the op-
eration day.
Results and Discussion: Demographic and clinical data in both groups were
comparable. In group A patients were significantly less hungry (1.5±1.4 vs
5.9±2.3, p<0.001), thirsty (1.5±1.3 vs 6.9±2.1, p< 0.001) and tired (2.6±1.7
vs 5.1±1.6, p<0.01) before the surgery. Intraoperative changes in the blood
pressure and ephedrine requirement did not differ between the groups but
the volume of infused fluids was higher in group B (1091mL vs 1375mL, 12.4
mL· kg-1 vs 15.2mL · kg-1 , p<0.05). Incidence of PONV was higher in group B.
Renal function, arterial blood oxygenation and plasma glucose levels were sim-
ilar in both group. In group B cardiac arrhythmia occurred in 3 patients on the
3rd day and atelectasis developed in 2 patients.
Conclusion(s): Oral carbohydrate fluids before major thoracic surgery signifi-
cantly improve patients comfort in the perioperative period. Potential dehydrata-
tion has no relevant clinical consequences and may be reversed by controlled
intraoperative volume replacement.
5AP2-5
Influence of the differential lung ventilation on stroke volume
variation
A. Usami, T. Terada, Y. Kotake, R. Ochiai
Anesthesiology, Toho University, School of Medicine, Oomori-nishi, Oota-ku,
Tokyo, Japan
Background and Goal of Study: Many clinical studies have demonstrated
the value of arterial pulse pressure variation or stroke volume variation (SVV) to
predict fluid responsiveness in mechanically ventilated patients, while the filling
pressures such as CVP or PCWP do not necessarily predict the cardiac preload.
Especially it might be true during thoracotomy, because a part of the pleural
pressure is atmospheric, thus affecting the transmural pressure of the major
vessels. The present study was conducted to clarify whether differential lung
ventilation (DLV) during thoracotomy could change SVV, compared with the
values during two-lung ventilation immediately before DLV.
Materials and Methods: Twenty adult patients, who underwent video-
assisted thoracic surgery (VATS), were studied, while the study was done be-
fore and during one-lung ventilation in lateral decubitus position. FloTrac/Vigileo
monitor was used to estimate cardiac output (CO), stroke volume and its varia-
tion (SV and SVV) by analyzing arterial pressure wave form. Mean arterial pres-
sure (MAP) and heart rate (HR) were also measured 5 min before DLV as well
as 5 min immediately after the onset of DLV. Student’s t-test was used to de-
termine statistical significance (p,0.05).
Results and Discussion: Patient’s characteristics were: Age 68±9, height
159.3±8.7 cm, weight 55.1±9.0 kg. After the application of DLV, SVV de-
creased significantly (13.4% to 8.5%), and the increase in PP and MAP was
significant (45 to 54 mmHg, and 65 to 70 mmHg, respectively), while CO and
HR did not change significantly. Since the measurement was continued before
and after the application of DLV, it is most likely that no major hemodynamic