Hypoxia In Anesthesia Term paper

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HypoxiaHypoxia

Intra-anesthesia hypoxia may be due to a problem with the anesthesia delivery system or a problem within the patient. The following are possible causes of hypoxia.

1) Decreased O2 supply.

A low supply of oxygen may be due to an inadequate FiO2 mixture. If the proportioning system fails to allow a proper ratio of N2O to O2 (3:1) then a hypoxic mixture will be delivered. A bobbin in the flowmeter that is stuck can fool the anesthetist into believing that more O2 is being delivered than in actuality. A depleted O2 supply will also cause hypoxia, as a decreased volume of O2 will be administered to the patient. If the pipeline valves or cylinder valves are closed then no O2 reaches the breathing circuit. The hospital should have an O2 backup supply on facility grounds for emergencies. It is important to note that cylinders are full and that hoses for pipelines are hooked up correctly and function prior to anesthetizing a patient. Pipeline pressures should read a minimum of 50 psig and O2 cylinders a minimum of 600 psig to assure adequate supply. Leaks can occur inside the machine, the CO2 absorber, at hose connections, in the bellows (especially hanging bellows), in the ventilator, flowmeter, and proportioner.(4) Broken valves allow leakage within the circuit. Tests for high and low pressure leaks should be performed prior to use of the machine. Do not use hoses that are damaged or frayed and have a potential for leakage. Incompetent unidirectional valves may cause rebreathing of gases and a hypoxic mixture.(3) Leaks can be detected by low expired volume, increase in ETCO2, or inadequate bellow expansion after expiration. Ventilator alarms for low airway pressures indicate a leak in the ventilator. Applying soapy water on connectors will result in bubbling if a leak is present.(1) Obstruction of flow into the circuit will prevent O2 from reaching the patient. This can occur as a result of sticking flow control valves, kinking of tubes, or foreign bodies in the system. Be sure to inspect all tubes and valves prior to use. When a cylinder or pipeline is hooked up incorrectly the DISS and PISS systems have been violated. Make sure that O2 connections are green, air is yellow, and N2O blue. Check to be sure that each cylinder has only 1 gasket at the connection. Closed circuits (Maplesons) give rise to the risk of rebreathing when inadequate gas flow is supplied. Be sure to identify the amount of FGF needed for each Mapleson system in order to prevent hypoxic rebreathing. A scavenger that is hooked up to high suction will pull FGF in and bypass the patient if the negative pressure relief valve is dysfunctional and cannot entrain air. A negative pressure alarm will alert the anesthetist to this problem. The collapsing reservoir bag will be the first indication that negative pressure is in the system. Any catheter that is inadvertently passed into the trachea with suction will steal O2 supply from the lungs.(1) Be sure to check NG placement after insertion by listening to air being injected into the stomach via the NG. An improperly placed ETT results in right mainstem bronchus or esophageal intubation. Verify ETT placement by chest movement, ETCO2 response, and bilateral breath sounds ausculated post intubation. It is a good standard of practice to preoxygenate the patient with O2 prior to intubation to store O2 in the FRC for physiologic backup. Reposition the ETT as indicated if improper placement is suspected. Inadequate O2 supply can be prevented by performing a machine checkout of the anesthesia equipment each day. Problems occurring intraoperatively should be detected by troubleshooting the equipment for disconnects or leaks. Temporary increase of FiO2 can be of assistance until the problem is found. O2 analyzers on the inspiratory limb should ensure adequate O2 delivery to the patient. The analyzer should alert the anesthetist when O2 delivery is less than 21% but may be as high as 100%.

2) Hypoventilation.

Anesthetic drugs and diseases that depress medullary function can cause deep sedation with low respiratory volume exchanges. Inadequate MV or apnea occurs frequently with use of anesthesia drugs.(4) MV for each patient should be calculated according to IBW prior to putting the patient to sleep to ensure adequate ventilation and perfusion. Extended intubation time sometimes requires intermittent ventilation and O2 via the ambu bag to prevent hypoxia between attempts. Patients who have been oversedated can be reversed with anti-narcotic drugs such as Narcan. Be sure to set proper TV and RR to meet each patients required MV....

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