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Oxygenation Impairment during Anesthesia: Influence of Age and Body Weight
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Hedenstierna laboratory.ORCID iD: 0000-0002-2923-6012
Karolinska Hosp, Dept Anesthesia & Intens Care, Huddinge, Sweden.
Univ Ferrara, Dept Morphol Surg & Expt Med, Sect Anesthesia & Intens Care, Ferrara, Italy.
Univ Bern, Univ Hosp, Dept Intens Care Med, Inselspital, Bern, Switzerland.
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2019 (English)In: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 131, no 1, p. 46-57Article in journal (Refereed) Published
Abstract [en]

Background: Anesthesia is increasingly common in elderly and overweight patients and prompted the current study to explore mechanisms of age- and weight-dependent worsening of arterial oxygen tension (Pao(2)). Methods: This is a primary analysis of pooled data in patients with (1) American Society of Anesthesiologists (ASA) classification of 1; (2) normal forced vital capacity; (3) preoxygenation with an inspired oxygen fraction (FIO2) more than 0.8 and ventilated with FIO2 0.3 to 0.4; (4) measurements done during anesthesia before surgery. Eighty patients (21 women and 59 men, aged 19 to 69 yr, body mass index up to 30 kg/m(2)) were studied with multiple inert gas elimination technique to assess shunt and perfusion of poorly ventilated regions (low ventilation/perfusion ratio [(V) over dot(A)/Q]) and computed tomography to assess atelectasis. Results: Pao(2) /FIO2 was lower during anesthesia than awake (368; 291 to 470 [median; quartiles] vs. 441; 397 to 462 mm Hg; P = 0.003) and fell with increasing age and body mass index. Log shunt was best related to a quadratic function of age with largest shunt at 45 yr (r(2) = 0.17, P = 0.001). Log shunt was linearly related to body mass index (r(2) = 0.15, P < 0.001). A multiple regression analysis including age, age(2), and body mass index strengthened the association further (r(2) = 0.27). Shunt was highly associated to atelectasis (r(2) = 0.58, P < 0.001). Log low (V) over dot(A)/Q showed a linear relation to age (r(2) = 0.14, P = 0.001). Conclusions: Pao(2)/FIO2 ratio was impaired during anesthesia, and the impairment increased with age and body mass index. Shunt was related to atelectasis and was a more important cause of oxygenation impairment in middle-aged patients, whereas low (V) over dot(A)/Q, likely caused by airway closure, was more important in elderly patients. Shunt but not low (V) over dot(A)/Q increased with increasing body mass index. Thus, increasing age and body mass index impaired gas exchange by different mechanisms during anesthesia.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS , 2019. Vol. 131, no 1, p. 46-57
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Anesthesiology and Intensive Care
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URN: urn:nbn:se:uu:diva-393526DOI: 10.1097/ALN.0000000000002693ISI: 000480727700012PubMedID: 31045901OAI: oai:DiVA.org:uu-393526DiVA, id: diva2:1354195
Available from: 2019-09-24 Created: 2019-09-24 Last updated: 2019-09-24Bibliographically approved

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Hedenstierna, GöranÖhrvik, John

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Clinical PhysiologyHedenstierna laboratoryCentre for Clinical Research, County of Västmanland
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