Anesthesiology
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To determine the effects of tidal volume (VT) and positive end-expiratory pressure (PEEP) on pulmonary oxygen exchange during endobronchial (one-lung) anesthesia, the authors studied the effects of VT at 8 and 16 per cent total lung capacity (TLC), at zero end-expiratory pressure (ZEEP), and at 10 cmH2O PEEP in 16 patients in the lateral position. Anesthesia was maintained with halothane and oxygen. During two-lung ventilation (FIO2 0.99), mean PaO2 and physiologic shunt (Qs/Qt) were 421 +/- 12 mmHg and 0.22 +/- 0.02, respectively. ⋯ At both levels of VT, PEEP reduced mean Qt by approximatley 10 per cent (P less than 0.01) and increased compliance (P less than 0.01). However, PEEP did not significantly affect mean Qs/Qt or mean arterial or pulmonary arterial pressures at either level of VT. There was considerable variation in PaO2 and Qs/Qt among patients.
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Halothane anesthesia administered to enzyme-induced animals in a hypoxic atmosphere consistently produced hepatic necrosis. Rats pretreated with phenobarbital were exposed to hypoxia at varying intervals after administration of halothane, enflurane, or isoflurane anesthesia. Anesthetics were administered at 1 MAC for 2 h. ⋯ The injury score of the enflurane and isoflurane groups were comparable to that of controls. We conclude that the potential for hypoxia-induced liver injury during recovery exists after halothane anesthesia. Neither enflurane nor isoflurane anesthesia produced significant hepatic injury in this model.