BJA Advance Access originally published online on July 15, 2005
British Journal of Anaesthesia 2005 95(3):410-416; doi:10.1093/bja/aei194
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Low- vs high-dose almitrine combined with nitric oxide to prevent hypoxia during open-chest one-lung ventilation
1 Department of Anesthesiology and 2 Department of Surgery, Hospital Universitari del Mar, Institut Municipal d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona, Barcelona, Spain
* Corresponding author: Department of Anesthesiology, Hospital Universitari del Mar, Passeig Maritim 25, 08003 Barcelona, Spain. E-mail: LGallart{at}imas.imim.es
Background. Almitrine combined with inhaled nitric oxide (NO) can prevent hypoxia during one-lung ventilation (OLV). The optimal dose of almitrine that would provide therapeutic advantage with few side-effects during open-chest OLV has not been established.
Methods. Forty-two patients undergoing thoracotomy were randomly allocated to three groups: placebo, almitrine 4 µg kg–1 min–1 and inhaled NO 10 p.p.m. (ALM4+NO), and almitrine 16 µg kg–1 min–1 and inhaled NO 10 p.p.m. (ALM16+NO). Gas exchange, haemodynamic and respiratory variables and plasma concentrations of almitrine and lactate were monitored. Measurements were obtained with the patient awake (baseline), after induction of anaesthesia with two-lung ventilation (control 2LV), 20 min after treatment (2LV+T), and then at 10, 20 and 30 min of OLV (OLV10', OLV20' and OLV30') with 
1.
Results. In the placebo group, OLV impaired 
and increased pulmonary shunt [16 (SD 7) kPa and 42 (10)% respectively]. These improved with ALM4+NO [26 (10) kPa and 31 (7)%; P<0.001]. ALM16+NO further improved to 36 (13) kPa (P<0.0001) but gave no improvement in the shunt. Mean pulmonary artery pressure was similar in the placebo and ALM4+NO groups [20 (4) vs 23 (5) mm Hg], whereas it was increased in the ALM16+NO group to 28 (8) mm Hg (P<0.01). Plasma concentrations of almitrine and lactate were unaltered by the treatments.
Conclusions. Low-dose almitrine (4 µg kg–1 min–1) together with inhaled NO significantly improves oxygenation during open-chest OLV, without modifying pulmonary haemodynamics. An increased dose of almitrine (16 µg kg–1 min–1) with inhaled NO further improves arterial oxygenation, but also increases mean pulmonary artery pressure.