Date of this Version

2021

Document Type

DNP Project

Abstract

Background: During lung surgeries, one-lung ventilation (OLV) produces severe ventilation and perfusion abnormalities that can delay patient recovery. Recent articles suggest that Dexmedetomidine may have protective effects on the lungs when hypoxic conditions exist and may improve hypoxic pulmonary vasoconstriction. Additional literature review is needed to confirm the reproducibility of these findings and generate evidence-based practice recommendations regarding the usage of Dexmedetomidine as an anesthesia adjunct during one-lung ventilation.

Aim: This quality improvement project aims to assess the best randomized control trials (RCTs) available regarding the benefits of Dexmedetomidine (DEX) coadministration during one-lung ventilation for pulmonary surgeries. By analyzing current evidence, the authors strive to introduce recommendations for anesthesia professionals that will reduce the prevalence of hypoxia and ventilation/perfusion abnormalities during pulmonary surgeries.

Study Selection: Seven RCTs, totaling 419 subjects, were included for this quality improvement project and selected based upon their inclusion of adult human participants undergoing general anesthesia with one-lung ventilation for pulmonary surgeries, written in the English language, from 1999 to 2020, published in scientific/peer-reviewed journals and available for download from the CINAHL, Medline, and EMBASE databases

Results: Six of the seven RCTs reviewed reported improved oxygenation amongst the group receiving Dexmedetomidine compared to the control; however, only four studies could establish statistical significance. One article observed a reduction in PaO2 in the DEX group that did not achieve statistical significance. After distribution of the online educational module and pretest and post test surveys, the number of anesthesia providers “very likely” to implement DEX co-administration during OLV increased between pre-test (n=2) and post-test (n=4).

Conclusion: Current evidence suggests that Dexmedetomidine coadministration with Propofol or inhalational anesthetic agents during one-lung ventilation will improve oxygenation intraoperatively. The mechanisms through which these benefits occur remains a debate and should be the focus of future research. After receiving a virtual module on the evidence gathered, more anesthesia providers indicate they are “very likely” to incorporate Dexmedetomidine during these types of surgery, signifying willingness to implement evidence-based practice changes.

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