Background
Methods
Literature review
Study inclusion criteria
Data extraction and statistical analysis
Study | Participants | Interventions | Abstracted outcomes |
---|---|---|---|
Ozcan et al [5] | 25 G-TIVA | G-TIVA/ISO: induced: fentanyl (3 μg.kg−1), propofol (BIS < 45) , vecuronium (0.1 mg.kg−1) | hemodynamic variables: HR, MAP; Intrapulmonary shunt: PvO2, PaO2,Qs/Qt |
25G-TIVA-TEA | Maintained: propofol or isoflurane respectively (according to BIS value) | ||
25 G-ISO | G-TIVA/ISO-TEA: T7-T8 epidural with initial 2 % lidocaine 2 mL ,0.1 % bupivacaine +0.1 mg.kg−1 morphine 10 mL, then induced the same as G-TIVA/ISO group | ||
25 G-ISO-TEA | Maintained: 0.1 % bupivacaine +0.1 mg.kg−1 morphine 7 ml.h-1, and maintained with propofol or isoflurane respectively (according to BIS value) | ||
Garutti et al. [6] | 30 G-TIVA | G-TIVA: induced: fentanyl (3 μg.kg−1), midazolam (2-3 mg) , propofol (2 mg/kg), rocuronium (0.6 mg/kg) | hemodynamic variables: HR, MAP; Intrapulmonary shunt: PvO2,PaO2,Qs/Qt,PaCO2, PH,SvO2,SaO2,CaO2,CvO2; Other: Hb, Paw |
30 G-TIVA-TEA | Maintained: fentanyl (3 μg.kg−1), propfol (6–7 mg.kg−1.h−1); rocuronium (0.5 mg.kg−1.h−1) | ||
G-TIVA-TEA: T6-T7 or T7-T8 epidural with initial 6–8 ml bupivacaine, then induced: same as G-TIVA group | |||
Maintained: 0.375 % bupivacaine (6–7 mL.h−1), propofol (6–7 mg.kg−1.h−1), rocuronium (0.6 mg/kg) | |||
Jung et al. [8] | 13G-TIVA | G-TIVA: induced: fentanyl (50–100 μg), propofol (4–5 μg/ml), vecuronium (0.1 mg.kg−1) | hemodynamic variables: HR, MAP, CVP. MPAP, PAOP, CO, SVR, PVR; Intrapulmonary shunt: PvO2,PaO2,Qs/Qt,PaCO2, PH, SvO2,SaO2; Other: Hb, Paw |
13G-TIVA-TEA-B | Maintained: 20 μg/ml remifentanil, 0.2 ml.kg−1.h−1; vecuronium (2–2.5 mg..h−1), propofol (according to BIS) | ||
13G-TIVA-TEA-S | G-TIVA-TEA-B: T5-T6 or T6-T7 epidural with initial 10 ml 5 % bupivacaine, then induced: same as G-TIVA group. | ||
Maintained: 0.25 % bupivacaine 0.1 ml.kg−1.h−1, propofol (6–7 mg.kg−1.h−1), vecuronium (2–2.5 mg..h−1), propofol (according to BIS) | |||
G-TIVA-TEA-S: T5-T6 or T6-T7 epidural with initial 10 ml 50 μg sufentanil , then induced :same as G-TIVA group | |||
Maintained: 1 μg/ml sufentanil 0.1 ml.kg−1.h−1), propofol (6–7 mg.kg−1.h−1), vecuronium (2–2.5 mg..h−1), propofol (according to BIS) | |||
Garutti et al. [9] | 37 G-TIVA | G-TIVA: induced: fentanyl (3 μg.kg−1), midazolam (0.04 mg/kg), propofol (2 mg/kg), rocuronium (0.6 mg.kg−1) | hemodynamic variables: HR, MAP; Intrapulmonary shunt: PvO2,PaO2,Qs/Qt,PaCO2, PH,SvO2,SaO2,CaO2,CvO2; Other: Hb, Paw |
Maintained: fentanyl (2–3 μg.kg−1), propfol (6–7 mg.kg−1.h−1); rocuronium (0.5 mg.kg−1.h−1) | |||
35 G-TIVA-TEA | G-TIVA-TEA: T6-T7 or T7-T8 epidural with initial meperidine 2 mg.kg−1 diluted in avolume of 10–12 mL, then induced :same as G-TIVA group | ||
Maintained: propofol (6–7 mg.kg−1.h−1), rocuronium(0.5 mg.kg−1.h−1) | |||
Dossow et al. [10] | 25 G-TIVA | G-TIVA: induced: fentanyl (5–10 μg.kg−1), thiopental (3–5 mg.kg−1), panccuronium (0.1 mg.kg−1) | hemodynamic variables; HR, MAP, PAOP, MPAP, CVP; Intrapulmonary shunt: PvO2,SVR,PVR |
25 G-TIVA-TEA | Maintained: fentanyl (5–10 μg.kg−1.h−1), propfol (6–10 mg.kg−1.h−1), panccuronium(0.05–0.15 mg.kg−1) | ||
G-TIVA-TEA: T6–7 or T7–8 epidural with initial 0.5 % bupivacaine 15 mg, then induced the same as G-TIVA group | |||
Maintained: 0.5 % bupivacaine (range 15–25 mg), propfol (6–10 mg.kg−1.h−1), panccuronium (0.05–0.15 mg.kg−1) | |||
Feng Y et al. [11] | 12G-TIVA | G-TIVA: induced :fentanyl (3 μg.kg−1), propfol (1 mg.kg−1) , Vecuronim (0.1 mg.kg−1) | hemodynamic variables; HR, MAP, MPAP, CVP, CO; Intrapulmonary shunt: PaO2, PaCO2, Qs/Qt |
Maintained: propfol (9–12 mg.kg−1.h−1), Vecuronim (0.1 mg.kg−1), T7–8 or T8–9 epidural with initial 1 % lidocaine 5 ml ,then maintained with normal saline 5 ml/h | |||
12G-TIVA-TEA | G-TIVA-TEA: T7–8 or T8–9 epidural with initial 0.5 % ropivacaine 7–9 ml, then induced the same as G-TIVA group. | ||
Maintaine with epidural ropivacaine 3–5 ml.h−1 combined with propfol (4.8–7.2 mg.kg−1.h−1), Vecuronim (0.1 mg.kg−1) | |||
Lu JH et al. [12] | 10 G-SEV | G-SEV: induced: fentanyl (100 μg ), propfol (2 mg.kg−1), vecuronim (0.1 mg.kg−1) | Intrapulmonary shunt: PaO2, PaCO2, PETCO2; Other: Hb, Paw |
10 G-SEV-TEA | Maintained: 0.5–1.3 MAC sevofrane, panccuronium (not mentioned) | ||
G-SEV-TEA: T5–6 or T6–7 epidural with initial 1.0 % lidocaine 5 ml then induced as G-SEV. | |||
Maintained: epidural with 1.0 % lidocaine 5 ml.45mins−1, combined with sevofrane(0.5–1.3MAC), panccuronium (not mentioned) | |||
Wang et al. [13] | 30 G-TIVA | G-TIVA: induced: fentanyl (2 μg.kg−1), midazolam (0.1 mg.kg-1), propfol (1.2–2.0 mg.kg−1) , vecuronim (0.1 mg.kg−1) | Intrapulmonary shunt: PaO2, PaCO2, Qs/Qt |
30G-TIVA-TEA | Maintained: fentanyl (0.2 μg.kg−1.h−1), propfol (3–6 mg.kg−1.h−1), vecuronium(0.05 mg.kg−1) | ||
G-TIVA-TEA: T6–7 epidural with initial 1.0 % lidocaine 5 ml then induced as G- TIVA. | |||
Maintained: epidural with 1.0 % lidocaine mixed with 0.25 % bupivacaine 5 ml.h−1, combined with propfol (3–6 mg.kg−1.h−1), vecuronium(0.05 mg.kg−1) | |||
Wang et al. [14] | 16 G-ISO | G-ISO: induced: fentanyl (2 μg.kg−1), midazolam (0.1 mg.kg-1), propfol (1.0–2.0 mg.kg−1), vecuronim (0.16 mg.kg−1) | hemodynamic variables: HR, MAP; Intrapulmonary shunt: PaO2, PaCO2, PvO2, Qs/Qt |
14 G-ISO-TEA | Maintained: isoflurane (2.0–4.0MAC), fentanyl (50 μg) | ||
G-ISO-TEA: T6–7 or T7-8epidural with initial 2.0 % lidocaine 3 ml then induced as G- ISO. | |||
Maintained: epidural with 0.5 % bupivacaine 5 ml.h−1, combined with propfol (4–6 mg.kg−1.h−1) | |||
Wang et al. [15] | 15 G-ISO | G-ISO: induced: fentanyl (2 μg.kg−1), midazolam (0.05 mg.kg-1), propfol (1.5–2.0 mg.kg−1), vecuronim (0.1 mg.kg−1) | hemodynamic variables: HR, MAP; Intrapulmonary shunt: PaO2/Fio2, Qs/Qt Other: Paw |
15 G-ISO-TEA | Maintained: isoflurane (0.5–1.3MAC), vecuronim (not mentioned) | ||
G-ISO-TEA: T10–11 epidural with initial 0.5 % lidocaine then induced as G- ISO. | |||
Maintained: epidural with 0.5 % lidocaine 5 ml.h−1, combined with isoflurane (0.5–1.3MAC), vecuronim (not mentioned) | |||
Chen et al. [16] | 13 G-TIVA | G-TIVA: induced: fentanyl (3 μg.kg−1), midazolam (0.1 mg.kg-1), propfol (1.0–2.0 mg.kg−1), vecuronim (0.1 mg.kg−1) | hemodynamic variables; HR, MAP; Intrapulmonary shunt: PaO2,PaCO2,PvO2,Qs/Qt, SvO2,SaO2,CaO2,CvO2, PETCO2, pH; Other: Paw |
13G-TIVA-TEA | Maintained: fentanyl (0.2 μg.kg−1.h−1), propfol (3–6 mg.kg−1.h−1), vecuronium(0.05 mg.kg−1) | ||
G-TIVA-TEA: T6–7 epidural with initial 1.0 % lidocaine mixed with 0.375 % bupivacaine 8–10 ml then induced as G- TIVA. | |||
Maintained: epidural with mixture of lidocaine and bupivacaine 5 ml.h−1, combined with propfol (3–6 mg.kg−1.h−1), vecuronium(0.05 mg.kg−1) | |||
Wu et al. [17] | 41G-TIVA | G-TIVA: induced: midazolam (0.05 mg.kg-1), fentanil, propfol and vecuronim (no details) | hemodynamic variables; HR, MAP; Intrapulmonary shunt: PaO2,PaCO2,Qs/Qt, pH |
41G-TIVA-TEA | Maintained: fentanil, propfol and vecuronium (no details, according to BIS). | ||
G-TIVA-TEA: T5–6 or T6–7 epidural with initial 0.5 % ropivacaine 7–12 ml then induced as G- TIVA. | |||
Maintained: epidural with 0.5 % ropivacaine 4–5 ml.h−1, combined with propfol and vecuronium (no details). | |||
Zhang et al. [18] | 43G-TIVA | G-TIVA: induced: midazolam (0.05 mg.kg-1), fentanil, propfol and vecuronim (no details) | hemodynamic variables; HR, MAP; Intrapulmonary shunt: PaO2,PaCO2,Qs/Qt, |
43G-TIVA-TEA | Maintained: fentanil, propfol and vecuronium (no details, according to BIS). | ||
G-TIVA-TEA: T5–6 or T6–7 epidural with initial 0.5 % ropivacaine 7–12 ml then induced as G- TIVA. | |||
Maintained: epidural with 0.5 % ropivacaine 4–6 ml.h−1, combined with propfol and vecuronium (no details). | |||
Sun et al. [19] | 12 G-ISO-TEA | G-ISO-TEA and G-TIVA-TEA: induced: T7–8 or T8–9 epidural with initial 0.5 % ropivacaine 7–9 ml then induced with fentanyl (3 μg.kg−1), midazolam (2-3 mg), propfol (1.5 mg.kg−1), vecuronim (0.1 mg.kg−1) | hemodynamic variables; HR, MAP,MPAP Intrapulmonary shunt: PaO2,PaCO2,Qs/Qt, pH |
12 G-TIVA-TEA | |||
Maintained: isoflurane and propfol respectively(no details, according to BIS). |
Results
Retrieved and included studies
Risk of bias in included studies
Thoracic Epidural analgesia on systemic hemodynamics variables
Median of Means (Range) | |||||
---|---|---|---|---|---|
All available data | No. of comparisons | TEA group | GA group | WMD (95 % CI) | P value |
During two-lung ventilation | |||||
HR(beat / min) | 7 | 72.98 (68.80 to 83.00) | 73.71 (69.00 to 78.00) | −1.33 [−5.16 to 2.50] | 0.50 |
MAP(mmHg) | 5 | 83.62 (76.00 to 87.00) | 86.26. (75.00 to 93.00) | −2.28 [−5.51 to 0.95] | 0.17 |
CO (L/min) | 2 | 5.50 (5.20 to 5.80) | 4.90 (4.90 to 4.90) | 0.55 [−0.21 to 1.30] | 0.16 |
CVP (cmH2O) | 3 | 7.00 (6.00 to 8.00) | 8.00 (6.00 to 9.00) | −1.00 [−3.94 to 1.95] | 0.51 |
SVR (dynes · sec · cm−5) | 3 | 1180.70(1022.00 to 1308.00) | 1401.67(1395.00 to 1405.00) | −246.16[−408.55 to -83.77] | 0.29 |
MPAP (mmHg) | 3 | 20.67 (18.00 to 22.00) | 18.67 (18.00 to 19.00) | 2.09 [−0.94 to 5.13] | 0.18 |
PAOP(mmHg) | 2 | 12.50 (12.00 to 13.00) | 13.00 (13.00 to 13.00) | −0.59 [−2.48 to 1.31] | 0.55 |
During one-lung ventilation within 30 min | |||||
HR(beat / min) | 7 | 74.14 (66.00 to 85.00) | 75.48 (73.20 to 80.00) | −3.28 [−5.89 to −0.67] | 0.01 |
MAP(mmHg) | 7 | 85.11 (81.00 to 89.00) | 93.29 (87.60 to 100.00) | −6.64 [−9.57 to −3.71] | <0.01 |
CO (L/min) | 2 | 5.40 (5.40 to 5.40) | 5.70 (5.70 to 5.70) | −0.30 [−1.15 to 0.55] | 0.49 |
CVP (cmH2O) | 3 | 8.30 (7.00 to 10.00) | 9.00 (8.00 to 11.00) | −0.61 [−1.72, 0.49] | 0.28 |
SVR (dynes · sec · cm−5) | 3 | 1003.33(890.00 to 1124.00) | 1349.67(1141.00 to 1454.00) | −319.99[−447.05 to -192.94] | <0.01 |
MPAP (mmHg) | 3 | 20.00 (19.00 to 22.00) | 23.00 (23.00 to 23.00) | −3.18 [−5.07 to −1.28] | <0.01 |
PAOP(mmHg) | 2 | 12.00 (12.00 to 12.00) | 13.00 (13.00 to 13.00) | −1.00 [−2.87 to 0.87] | 0.30 |
One-lung ventilation more than 30 min | |||||
HR(beat / min) | 6 | 76.00 (75.00 to 87.00) | 75.32 (71.50 to 80.00) | −0.94 [−3.81 to 1.92] | 0.52 |
MAP(mmHg) | 6 | 84.12 (75.00 to 87.00) | 91.85 (85.80 to 98.00) | −6.33 [−9.25 to −3.41] | <0.01 |
CO (L/min) | 4 | 5.55 (4.70 to 6.10) | 5.55 (5.50 to 5.60) | −0.07 [−0.64 to 0.51] | 0.82 |
CVP (cmH2O) | 4 | 7.75 (7.00 to 9.00) | 8.00 (7.00 to 9.00) | −0.37 [−1.24 to 0.51] | 0.41 |
SVR (dynes · sec · cm−5) | 4 | 1168.50(981.00 to 1356.00) | 1209.00(1209.00 to 1209.00) | −38.17[−201.75 to 125.42] | 0.07 |
MPAP (mmHg) | 4 | 20.00 (18.00 to 21.00) | 22.50 (22.00 to 23.00) | −2.05 [−3.35 to −0.75] | <0.01 |
PAOP(mmHg) | 4 | 12.50 (12.00 to 13.00) | 13.50 (13.00 to 14.00) | −1.11 [−2.40 to 0.18] | 0.09 |
Re-two ventilation | |||||
HR(beat / min) | 5 | 74.40 (65.00 to 87.00) | 71.60 (67.00 to 78.00) | −0.41 [−4.08 to 3.25] | 0.82 |
MAP(mmHg) | 5 | 84.40 (81.00 to 87.00) | 95.80 (92.00 to 95.00) | −11.83 [−15.87 to −7.79] | <0.01 |
CO (L/min) | 2 | 5.55 (5.50 to 5.60) | 5.20 (5.20 to 5.20) | 0.35 [−0.58 to 1.29] | 0.46 |
CVP (cmH2O) | 3 | 7.67 (7.00 to 9.00) | 6.33 (6.00 to 7.00) | 1.20 [−0.15 to 2.55] | 0.08 |
SVR (dynes · sec · cm−5) | 3 | 1157.00(1052.00 to 1316.00) | 1358.67(1226.00 to 1425.00) | −186.69[−312.37 to −61.01] | <0.01 |
MPAP (mmHg) | 3 | 19.67 (18.00 to 21.00) | 21.33 (21.00 to 22.00) | −1.77 [−3.61 to 0.07] | 0.06 |
PAOP(mmHg) | 2 | 11.00 (10.00 to 12.00) | 12.00 (12.00 to 12.00) | −1.03[−2.75 to 0.68] | 0.24 |
Thoracic Epidural analgesia on oxygenation and pulmonary shunt fraction variables
Median of Means (Range) | |||||
---|---|---|---|---|---|
All available data | No. of comparisons | TEA group | GA group | WMD (95 % CI) | P value |
During two-lung ventilation | |||||
PaO2 (mmHg) | 13 | 382.42(205.00 to 85.00) | 377.92(191.0 to 453.00) | 6.29 [0.04 to 12.17] | 0.35 |
PaCO2 (mmHg) | 10 | 39.67 (32.50 to 37.6) | 40.23 (35.60 to 37.40) | −0.21 [−1.11 to 0.68] | 0.64 |
PvO2 (mmHg) | 7 | 51.50(48.00 to 55.0) | 51.62(48.0 to 53.30) | 0.27 [−1.51 to 2.06] | 0.76 |
Qs/Qt (%) | 13 | 14.80 (4.90 to 22.50) | 15.50 (3.95 to 21.60) | 0.02[−0.47 to 0.50] | 0.95 |
SvO2 (%) | 4 | 85.37(83.30 to 87.10) | 86.68(84.90 to 88.20) | −1.22[−2.36 to −0.07] | 0.58 |
SaO2 (%) | 4 | 99.75(99.70 to 99.90) | 99.45(99.00 to 99.90) | −0.06[−0.08 to −0.04] | 0.30 |
PH | 4 | 7.43 (7.42 to 7.43) | 7.44 (7.43 to 7.44) | −0.01 [−0.02 to 0.00] | 0.21 |
Paw (cmH2O) | 4 | 18.63 (17.00 to 20.00) | 19.03 (17.00 to 21.40) | −0.24 [−1.14 to 0.66] | 0.60 |
During one-lung ventilation within 30 min | |||||
PaO2 (mmHg) | 10 | 166.90(118.00 to 211.00) | 171.2(122.00 to 201.00) | −16.52[−21.98 to -11.05] | <0.01 |
PaCO2 (mmHg) | 10 | 37.12 (36.10 to 44.20) | 36.85(34.20 to 42.20) | 0.29 [−0.53 to 1.10] | 0.49 |
PvO2 (mmHg) | 7 | 47.78(44.90 to 54.00) | 46.14(44.50 to 51.00) | 1.13 [−0.50 to 2.76] | 0.17 |
Qs/Qt (%) | 10 | 33.32 (27.30 to 39.50) | 32.77 (26.70 to 40.60) | 2.53 [1.35 to 3.72] | <0.01 |
SvO2 (%) | 4 | 80.53(78.30 to 82.60) | 81.58(78.40 to 84.20) | −1.13[−2.74 to 0.48] | 0.17 |
SaO2 (%) | 4 | 97.98(96.80 to 99.30) | 97.65(97.30 to 98.00) | 0.74[0.33 to 1.15] | <0.01 |
PH | 4 | 7.43 (7.42 to 7.44) | 7.44 (7.42 to 7.46) | −0.01 [−0.02 to 0.001] | 0.41 |
Paw (cmH2O) | 4 | 28.00 (23.00 to 32.50) | 27.00 (24.00 to 30.90) | 1.95 [1.61 to 2.28] | <0.01 |
One-lung ventilation more than 30 min | |||||
PaO2 (mmHg) | 11 | 162.27(117.00 to 203.00) | 168.72(148.00 to 221.00) | −14.23[−20.81 to -7.65] | <0.01 |
PaCO2 (mmHg) | 11 | 36.61 (33.90 to 44.60) | 36.78 (35.00 to 44.20) | −0.22 [−0.96 to 0.53] | 0.57 |
PvO2 (mmHg) | 6 | 44.70(42.60 to 46.10) | 44.98(43.40 to 46.60) | −0.61[−2.23 to 1.02] | 0.46 |
Qs/Qt (%) | 12 | 34.40 (33.60 to 42.70) | 32.67 (32.10 to 40.90) | 2.77 [1.81 to 3.74] | <0.01 |
SvO2 (%) | 6 | 79.33(77.40 to 81.10) | 81.97(78.50 to 83.90) | −2.39[−3.73 to −0.99] | <0.01 |
SaO2 (%) | 6 | 97.68(96.60 to 98.10) | 98.20(97.20 to 99.00) | −0.63[−1.23 to −0.04] | 0.04 |
PH | 6 | 7.43 (7.43 to 7.44) | 7.44 (7.41 to 7.46) | 0.00 [−0.01 to 0.01] | 0.50 |
Paw (cmH2O) | 6 | 26.80 (24.00 to 32.50) | 26.72 (24.00 to 31.40) | 0.87 [0.54 to 1.20] | <0.01 |
Re-two ventilation | |||||
PaO2 (mmHg) | 7 | 322.28(173.00 to 482.00) | 307.28(168.00 to 407.00) | 11.54[−4.25 to 27.34] | 0.15 |
PaCO2 (mmHg) | 3 | 37.8 (34.00 to 46.10) | 35.6 (34.90 to 36.90) | −0.60 [−3.03 to 1.83] | 0.63 |
PvO2 (mmHg) | 5 | 47.82(43.00 to 50.00) | 48.68(46.20 to 51.00) | 0.06[−2.24 to 2.36] | 0.96 |
Qs/Qt (%) | 6 | 18.55(15.30 to 24.50) | 20.15(15.50 to 24.80) | −1.27 [−2.73 to 0.20] | 0.09 |
SvO2 (%) | 2 | 81.90(81.50 to 82.30) | 85.30(85.30 to 85.30) | −3.62[−6.28 to −0.95] | 0.80 |
SaO2 (%) | 2 | 99.75(99.70 to 99.80) | 99.00 (99.00 to 99.00) | 0.75[0.52 to 0.98] | 0.67 |
PH | 2 | 7.42 (7.41 to 7.42) | 7.42 (7.42 to 7.42) | 0.00 [−0.03 to 0.02] | 0.77 |
Paw (cmH2O) | 2 | 19.00 (18.00 to 20.00) | 18.00 (18.00 to 18.00) | 0.95 [−0.81 to 2.71] | 0.29 |