ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Effects of positioning and ventilation strategy on the parameters of respiratory mechanics and blood gases during video-assisted thoracoscopic esophagectomy
Ziya Salihoğlu1, Şener Demiroluk1, Ahmet Demirkaya2, Ezel Ersen2, Bilgi Baca3, İsmail Hamzaoğlu3, Tayfun Karahasanoğlu3
1Department of Anesthesiology and Reanimation, Cerrahpaşa Medicine Faculty of İstanbul University, İstanbul
2Department of Thoracic Surgery, Cerrahpaşa Medicine Faculty of İstanbul University, İstanbul
3Department of General Surgery, Cerrahpaşa Medicine Faculty of İstanbul University, İstanbul
Background: In this study, the effects of positioning and ventilation strategy on respiratory mechanics and blood gases throughout video-assisted thoracoscopic (VAT) esophagectomy were evaluated.

Methods: After obtaining approval from the ethics committee, nine patients (2 females, 7 males; mean age 60 years; range 39 to 74 years) who underwent a VATesophagectomy for esophageal cancer with ASA I (Society of Anesthesiologists I) or II physical classification were included in the study. Standard general anesthesia was performed. Dynamic respiratory compliance, airway resistance, and peak inspiratory pressure were monitored. Measurements were recorded in five periods; 10 minutes after intubation (Intubation: T1, control), 10 minutes after left lateral decubitus position (Left lateral: T2), 10 minutes after single lung ventilation with left lateral decubitus position (Single lung-initiation: T3), 10 minutes before single lung ventilation ends (Single lung-end: T4), and 10 minutes after supine position (Supine: T5). Samples of arterial blood gases were obtained at the same periods.

Results: Dynamic respiratory compliance records were 66±12 ml. cm. H2O-1, 53±8 ml. cm. H2O-1, 49±8 ml. cm. H2O-1, 48±8 ml. cm. H2O-1 and 52±11 ml. cm. H2O-1, in T1, T2, T3, T4 and T5, respectively. The changes were significant in T2, T3, T4 and T5 (p<0.05).

Conclusion: According to our results, respiratory mechanics, oxygenation and partial oxygen pressures were negatively affected during VAT-esophagectomy compared to the control group, especially during the single lung ventilation period.

Keywords : Esophagectomy; left lateral decubitus and supine position; patient positioning; respiratory mechanics; thoracoscopy; video-assisted thoracoscopic esophagectomy
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