Reference: 1 Rawal N. Results from an interactive audience survey of the current state-of- the-art practices for delivery of postoperative analgesia. Eur J Anaesthesiol 2006; 23(Suppl 37): 221. O-43 Effects of recruitment manoeuvres on lung parenchyma during one lung ventilation in a rabbit model H.Y. Cetin 1 , F.Z. Askar 1 , O. Samancilar 2 , A. Veral 3 , U. Cagirici 2 1 Department of Anaesthesiology and Intensive Care, 2 Department of Thoracic Surgery, 3 Department of Pathology, Ege University, School of Medicine, Izmir, Turkey Introduction: Recruitment manoeuvres are among the techniques to relieve hypoxaemia occurring during one lung ventilation [1]. This study aimed to show their effects on lung parenchyma in one lung ventilated healthy rabbits. Method: Twenty-four male New Zealand rabbits were selected randomly into four groups: peak inspiratory pressure (PIP) 30, PIP40, PIP50 and con- trol group. After anaesthesia induction, tracheotomy and intubation, the rab- bits were ventilated with a Siemens Servo 900C ventilator (Siemens-Elma AB, Solna, Sweden). Ventilation was pressure controlled, inspiration/expira- tion ratio: 0.5, and fraction of inspired oxygen of 1. Pressure level and breathing frequency were adjusted to supply a tidal volume of 10 mL kg -1 and an end-tidal CO 2 between lungs and fifteen minutes later, while main- taining a supine position, the endotracheal tube was advanced further into the right main stem bronchus until total collapse of the left lung while all lobes of the right lung were ventilated. Afterwards, all rabbits were one lung ventilated without any change in ventilation parameters for 10 minutes. Following this, PIP30, PIP40 and PIP50 groups were ventilated with PIP/PEEP levels at 30 cmH 2 O/10 cmH 2 O; 40 cmH 2 O/10 cmH 2 O, and 50 cmH 2 O/10 cmH 2 O respectively for ten consecutive breaths for alveolar recruitment. Rabbits in the control group were ventilated 10 more breaths with the same parameters as in the start of one lung ventilation. Arterial blood samples were withdrawn at the end of double lung ventilation, after 10 minutes of one lung ventilation and at the end of recruitment for blood gas analysis. Samples obtained from ventral part of the upper lobe, ventral part of the middle lobe, ventral (nondependent) part of the lower lobe and dorsal (dependent) part of the lower lobe were examined for injury by light microscopy. The data were analysed by analysis of variance, Tukey HSD test and paired samples t-test. P  0.05 was considered significant. Results: The groups ranked from lowest to highest value according to total severity scores are as follows; 1) PIP30, 2) PIP40, 3) PIP50, 4) control (P = 0.000). Only post-recruitment PaO 2 levels were statistically significantly higher in PIP30 and PIP40 group but no statistically significant difference in PIP50 group when compared with the control group (P = 0.031; P = 0.039; P = 0.076). Discussion: As peak airway pressure increases in recruitment manoeuvres in one lung ventilation, the alveolar injury gets worse. On the other hand, ventilation without recruitment manoeuvres may cause more significant alveolar injury. Reference: 1 Tusman G, Böhm SH, Melkun F et al. Alveolar recruitment strategy increases arterial oxygenation during one-lung ventilation. Ann Thorac Surg 2002; 73: 1204–1209. O-44 Comparison of pre-emptive and postoperative thoracic epidural analgesia on respiratory function tests Z.S. Ulke, I. Baskan, M. Eren, E. Ozden, S. Dilege, M. Senturk Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey Introduction: Adequate analgesia is of special interest in thoracic surgery for postoperative morbidity and pre-emptive analgesia is more effective in this kind of surgery [1]. Thoracic epidural analgesia (TEA) is the preferable method as it provides effective analgesia and also improves respiratory function after surgery [2]. We compared the effects of pre-emptive and postoperative TEA in thoracic surgery for pain control and respiratory function tests (RFT). Method: Thirty patients for elective thoracotomy were included in the study and all patients had a thoracic epidural catheter ( T7-8 or T8-9). In the first group (G1) 0.1% bupivacaine +1 g/mL fentanyl infusion was started after a 10 mL bolus before skin incision; and 7 mL/h infusion continued during surgery. In the second group (G2) the bolus dose was given at the end of surgery. Anaesthesia was maintained with a propofol infusion. A postoperative analgesia protocol was the same for both groups (5 mL/h infusion with 3 mL bolus and lock out of 30 min). Postoperative follow-up included visual analogue scale (VAS), bolus doses and haemodynamic data at first, 12th, 24th, 36th hours. RFTs were performed at 36th hour and at first week postoperatively. Results: VAS were significantly lower in G1 at all times of the study. RFTs were decreased in all patients, but the rate of decrease in G1 was significantly less (postoperative/preoperative FEV 1 :74.6  14.4% vs. 59.3  9% P = 0.0016) (postoperative/preoperative FVC: 76.1  13.3% vs. 55.9  8.4% p  0.001) at 36th hour. There was no difference in RFTs after one week. Conclusion: Besides providing better postoperative analgesia, pre- emptive TEA is also associated with better preserved RFTs compared to postoperative TEA. References: 1 Senturk M, Ozcan PE, Talu GK, et al. The effects of three different analgesia tech- niques on long-term postthoracotomy pain. Anesth Analg 2002; 94: 11–15. 2 Slinger P, Shennib H, Wilson S. Postthoracotomy pulmonary function: a comparison of epidural versus intravenous meperidine infusions. J Cardiothorac Vasc Anesth 1995; 9: 128–134. O-45 Carinal resection: anaesthetic management and results after two years’ experience M a J. Jiménez, E. Martínez, A.G. Caro, G. Fita, I. Rovira, P. Matute, C. Gomar, J. M a Gimferrer, P. Macchiarini Hospital Clinic, Universitat de Barcelona, Barcelona, Spain Introduction: Carinectomy is considered the treatment of choice in lesions of the tracheal carina or tracheobronchial angle. Its usefulness for carcinoma is still controversial and represents a challenge for surgeons and anaesthe- siologists [1,2]. The aim is to present our two years of surgery experience. Method: Between April 2005 and November 2006, fourteen patients with non-small cell lung cancer underwent carinal resection and mediastinal dis- section. Clinical notes were reviewed retrospectively: age, sex, length of stay, tumour staging, histopathological diagnosis, complementary treatment (chemotherapy, radiotherapy), type of surgery, approach, anaesthetic man- agement (TIVA technique), monitoring of cerebral activity by BIS and Somanetics ® (SrO 2 cerebral), protective ventilation with very low tidal vol- umes (TV) and apnoeic hyperoxygenation as a ventilation technique during the tracheobronchial anastomosis), postoperative complications, mortality and length of hospital stay. Results: Twelve males and 2 females (mean age 55  8.6 years), underwent carinal resection. Five had received neo-adjuvant chemotherapy; 9 under- went sleeve pneumonectomy, 4 right lobectomy with carinal resection and one, only carinal resection. The approach was median sternotomy in 6 patients and right thoracotomy in 8. Hypercapnia secondary to low TV and apnoeic oxygenation was the main anaesthetic management problem; hypoxaemia occasionally needed cross surgical field ventilation. Fluid overload, repetitive pulmonary atelectasis and high oxygen blood concentration were avoided. All patients were extubated within 24 hours after surgery. Mortality was 7% (1 patient in the first year) and morbidity rate was 64% (9 patients). Purulent tracheobronchitis, haemodynamic instability and pneumothorax, being the main complications. Suture dehiscence occurred in one case (7%). Length of hospital stay was 17  21 days and survival was 79% after a follow-up (4–24 months). Conclusions: Carinal resection is a feasible procedure despite previous neo-adjuvant treatment. The anaesthetic management is particularly difficult and requires a learning curve for intraoperative and postoperative events. However in centres with expertise these procedures show a low rate of pitfalls and complications. References: 1 de Perrot M, Fadel E, Mercier O, et al. Long term results after carinal resection for carci- noma: does the benefit warrant the risk? J Thorac Cardiovasc Surg 2006; 131: 81–89. 2 Mitchell JD, Mathisen DJ, Wright CD, et al. Resection for bronchogenic carcinoma involving the carina: long-term results and effect of nodal status on outcome. J Thorac Cardiovasc Surg 2001; 121: 465–471. 14 Haemostasis Haemostasis O-46 Similar deleterious effects of HES 130/0.4 and HES 200/0.5 on blood coagulation after cardiac surgery A. Schramko, R. Suojaranta-Ylinen, A. Kuitunen, S. Kukkonen, T. Niemi Helsinki University Central Hospital, Helsinki, Finland Introduction: Even a rapidly degradable HES, i.e. HES 200 kDa/0.5, may increase the risk of postoperative blood loss when administered immediately after cardiac surgery [1]. HES 130/0.4 has been reported to have minimal effect on haemostasis [2] and may be suitable during the period of increased