uu.seUppsala University Publications
Change search
ReferencesLink to record
Permanent link

Direct link
Oxygen and anesthesia: what lung do we deliver to the post-operative ward?
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
2012 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 56, no 6, 675-685 p.Article, review/survey (Refereed) Published
Abstract [en]

Anesthesia is safe in most patients. However, anesthetics reduce functional residual capacity (FRC) and promote airway closure. Oxygen is breathed during the induction of anesthesia, and increased concentration of oxygen (O2) is given during the surgery to reduce the risk of hypoxemia. However, oxygen is rapidly adsorbed behind closed airways, causing lung collapse (atelectasis) and shunt. Atelectasis may be a locus for infection and may cause pneumonia. Measures to prevent atelectasis and possibly reduce post-operative pulmonary complications are based on moderate use of oxygen and preservation or restoration of FRC. Pre-oxygenation with 100% O2 causes atelectasis and should be followed by a recruitment maneuver (inflation to an airway pressure of 40 cm H2O for 10 s and to higher airway pressures in patients with reduced abdominal compliance (obese and patients with abdominal disorders). Pre-oxygenation with 80% O2 may be sufficient in most patients with no anticipated difficulty in managing the airway, but time to hypoxemia during apnea decreases from mean 7 to 5 min. An alternative, possibly challenging, procedure is induction of anesthesia with continuous positive airway pressure/positive end-expiratory pressure to prevent fall in FRC enabling use of 100% O2. A continuous PEEP of 7–10 cm H2O may not necessarily improve oxygenation but should keep the lung open until the end of anesthesia. Inspired oxygen concentration of 30–40%, or even less, should suffice if the lung is kept open. The goal of the anesthetic regime should be to deliver a patient with no atelectasis to the post-operative ward and to keep the lung open.

Place, publisher, year, edition, pages
2012. Vol. 56, no 6, 675-685 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-175674DOI: 10.1111/j.1399-6576.2012.02689.xISI: 000305070400003PubMedID: 22471648OAI: oai:DiVA.org:uu-175674DiVA: diva2:532470
Available from: 2012-06-11 Created: 2012-06-11 Last updated: 2012-07-30Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full textPubMed

Search in DiVA

By author/editor
Hedenstierna, Göran
By organisation
Clinical Physiology
In the same journal
Acta Anaesthesiologica Scandinavica
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 195 hits
ReferencesLink to record
Permanent link

Direct link