Effect Of Ketamine Infusion In Patients With COPD Applied One Lung Ventilation
Condition: Chronic Obstructive Pulmonary Disease Mild; Chronic Obstructive Pulmonary Disease Moderate; Chronic Obstructive Pulmonary Disease Severe; Lungcancer; Anesthesia
MeSH terms: Lung Neoplasms; Lung Diseases; Lung Diseases, Obstructive; Pulmonary Disease, Chronic Obstructive
Study type: Interventional
Phase: Phase 4

Summary: 
      Chronic obstructive pulmonary disease (COPD) patients often undergo thoracic surgery due to
      lung cancer and emphysematous changes. One lung ventilation (OLV) used in thoracic surgery
      aggravates hypoxia and hypercapnia increasing intrapulmonary shunt and dead space.Ketamine
      provide bronchodilation by inhibiting the reuptake of catecholamines in the circulation. It
      also serves relaxation of bronchial smooth muscle. Our aim in this study, effects of ketamine
      on arterial oxygenation, the shunt fraction and the lung mechanics in patients with COPD who
      administered OLV because of thoracic surgery. Thirty patients with COPD who undergo
      thoracotomy for lung lobectomy will be included in this study. Patients will be randomly
      divided to a control group (%0,9 saline- CG) or a keta (ketamine- KG) group. KG will be
      administered 1 mg/kg ketamine bolus, then 0,5 mg/kg/hour ketamine infusion after the
      induction, CG will be administered sline bolus, then saline infusion. Peak airway pressure
      (Ppeak), plato airway pressure (Pplato), static compliance, shunt fraction, PaO2/FiO2 and
      arteriel blood gas values (Pa02, PaC02) will be recorded before initiation of OLV and 30
      minutes intervals after initiation of OLV.To evaluate the postoperative pulmonary
      complications, Pa02, PaC02 in blood gas and Pa02/Fi02 values will be recorded 20 minute after
      arrival at postoperative care unit. Patients will be evaluated for pneumonia, atelectasis and
      acute lung injury at postoperative 72 h and findings will be recorded. 30 day mortality will
      be recorded.
    

Detailed description: 
      Chronic obstructive pulmonary disease (COPD) is a risk factor for cardiopulmonary morbidity
      and mortality after thoracic surgery. The elastic recoil reduction and structural changes in
      the small airways and alveoli cause pulmonary air trapping and hyperinflation in patients
      with COPD. Chronic alveolar hypoxia results structural changes in the pulmonary arteriol such
      as medial hypertrophy and muscularization. Ventilation-perfusion mismatch and from the right
      to left shunt cause hypoxia in patients with COPD. COPD patients often undergo thoracic
      surgery due to lung cancer and emphysematous changes. One lung ventilation (OLV) used in
      thoracic surgery aggravates hypoxia and hypercapnia increasing intrpulmonary shunt and dead
      space. Positive end expirium pressure (PEEP) and alveolary recruitment are not applicable to
      treat hypoxia because of development of high intrinsic PEEP. Ketamine is an intravenous
      general anesthetic agent widely used for many years and has sympathomimetic bronchodilator
      features on the airway. Ketamine provide bronchodilation by inhibiting the reuptake of
      catecholamines in the circulation. It also serves relaxation of bronchial smooth muscle. Our
      aim in this study, effects of ketamine on arterial oxygenation, the shunt fraction and the
      lung mechanics in patients with COPD who administered OLV because of thoracic surgery. This
      prospective, randomized, double blinded, controlled study will be conducted following
      Cukurova University Faculty of Medicine Ethics Committee approval and written informed
      patient consent. Thirty patients who undergo thoracotomy for lung lobectomy will be included
      in this study.Patients will be monitored for electrocardiography (ECG), oxygen saturation
      (Sa02) and non-invasive blood pressure and applied thoracal (T 5-8) epidural catheter which
      will be used postoperative analgesia. After the induction of anesthesia, patients will be
      intubated with double lumen tube (DLT). The position of the DLT will be confirmed with
      fiberoptic bronchoscope. Anesthesia will be maintained with %4-6 desflurane and 0,25-0,5
      microgram/dk/min remifentanil. Desflurane will be titrated to maintain a bispectral index of
      40 to 60.Patients will be randomly divided to a control group (%0,9 saline- CG) or a keta
      (ketamine- KG) group. KG will be received 1 mg/kg ketamine bolus, then 0,5 mg/kg/hour
      ketamine infusion will be administered until the end of operation, CG will be received bolus
      saline, then saline infusion will be administered until the end of operation . Patients will
      be ventilated with volume controlled ventilation (VCV), tidal volume (TV) 8 mlt/kg and rate
      of inspirium:expirium (I:E)=1:2,5 during two lung ventilation. During OLV, the lungs were
      ventilated with VCV, TV 5 mlt/kg, I:E=1:2,5, PEEP= 5cmH20. The fraction of inspired oxygen
      (Fi02) will initially set at 0,6. In cases of desaturation to Sa02 less than 95%, Fi02 will
      be increased by 0,2 up to 1,0. Peak airway pressure (Ppeak), plato airway pressure (Pplato),
      static compliance, shunt fraction and arteriel blood gas values (Pa02, PaC02) will be
      recorded before initiation of OLV and 30 minutes intervals after initiation of OLV. To
      evaluate the postoperative pulmonary complications, Pa02, PaC02 in blood gas and Pa02/Fi02
      values will be recorded 20 minute after and 1 hour after arrival at postoperative care unit.
      If the patient shows signs of dyspnea and Pa02/Fi02<300, the patient will be admitted
      intensive care unit. Patients will be evaluated for pneumonia, atelectasis and acute lung
      injury at postoperative 72 h and findings will be recorded. 30 day mortality will be
      recorded.
    

Intervention name(s): Ketamine; Saline
Intervention type(s): Drug; Drug
Intervention description(s): After induction, patients will be received 1 mg/kg ketamine bolus, then administered 0,5 mg/kg/hour ketamine infusion intraoperatively.; After induction, patients will be received saline bolus, then will be administered saline infusion intraoperatively.
Other intervention name(s): Ketalar; %0,9 NaCl
Intervention MeSH terms: Ketamine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Care Provider)
Primary purpose: Prevention
Keywords: Ketamine; One lung ventilation; Chronic obstructive pulmonary disease