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BJA Advance Access published online on July 15, 2005
British Journal of Anaesthesia, doi:10.1093/bja/aei194
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved. For Permissions, please e-mail: journal.permissions@oupjournals.org
Accepted May 16, 2005

Clinical Investigation

Low- vs high-dose almitrine combined with nitric oxide to prevent hypoxia during open-chest one-lung ventilation

T. Silva-Costa-Gomes 1, L. Gallart 1*, J. Vallès 1, L. Trillo 1, J. Minguella 2, and M. M. Puig 1

1 Department of Anesthesiology, Hospital Universitari del Mar, Institut Municipal d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona, Barcelona, Spain
2 Department of Surgery, Hospital Universitari del Mar, Institut Municipal d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona, Barcelona, Spain

* To whom correspondence should be addressed.
L. Gallart, E-mail: LGallart{at}imas.imim.es


  Abstract

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 FIO21.

Results. In the placebo group, OLV impaired PaO2 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 PaO2 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.

Keywords: almitrine; complications, hypoxia; nitric oxide; surgery, thoracic.
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