Cardiothoracic & vascular anesthesia
Impact of pharmacological interventions on intrapulmonary shunt during one-lung ventilation in adult thoracic surgery: a systematic review and component network meta-analysis
Authors' conclusion
Adding N2O or almitrine to propofol anaesthesia reduced intrapulmonary shunt during one-lung ventilation. Halogenated anaesthetics increased shunt in comparison with propofol.
Study context
- Population
- Adults undergoing thoracic surgery under OLV
- Participants
- 2,788 adults · 55 RCTs
- Comparison
- Pharmacological interventions vs propofol anaesthesia
- Outcome
- Intrapulmonary shunt fraction during OLV
Methodological detailsrandom-effects, Confidence in Network Meta-Analysis (CINeMA) certainty assessment
- Random-effects
- CINeMA certainty assessment
Pooled result
As reported in the abstract
Intrapulmonary shunt fraction
Each group vs propofolMD, % (95% CI)P value
N2O
−15(−25 to −5)
P = 0.003Almitrine
−13(−20 to −6)
P < 0.001Combined epidural anaesthesia
3(1–5)
P = 0.005Sevoflurane
5(2–8)
P < 0.001Isoflurane
6(4–9)
P < 0.001Desflurane
9(4–14)
P = 0.001Further pooled results
| Outcome | MD (mm Hg) (95% CI) | P value | |
|---|---|---|---|
| PaO2/FiO2Almitrine vs Propofol | 147 (58–236) | P = 0.001 | |
| PaO2/FiO2Dopexamine vs Propofol | 88 (4–171) | P = 0.039 | |
| PaO2/FiO2Iloprost vs Propofol | 81 (4–158) | P = 0.038 | |
| −1000100200300Difference, mm Hg (linear scale) |
Original publication
Impact of pharmacological interventions on intrapulmonary shunt during one-lung ventilation in adult thoracic surgery: a systematic review and component network meta-analysis. Br J Anaesth. Published 26 October 2022. doi:10.
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