PMID: 7026450Jan 1, 1981Paper

Hypoxemia and general anesthesia: an analysis of distribution of ventilation and perfusion

International Anesthesiology Clinics
P L Klineberg, R J Bagshaw

Abstract

There is now overwhelming evidence that anesthesia with and without muscle paralysis is associated with an increased inefficiency of gas exchange, with abnormal oxygenation and CO2 elimination. There is great variation in the degree of this change from individual to individual; it results from increased right-to-left intrapulmonary shunting, increased alveolar dead space, increased dispersion of VA/Q ratios, altered cardiac output, and changes of the ODC. In normal subjects the abnormality can be largely explained by mismatch of ventilation and perfusion. Distribution of perfusion is determined by right ventricular output, the distribution of pulmonary vascular impedance, and their mutual interaction. This interaction is specifically influenced by gravity, right heart dynamics, systemic hemodynamics, particularly via the left atrium, and lung inflation. General anesthesia modifies the distribution of perfusion, largely to the extent that the above determinants are changed by: the particular anesthetic agents used; the posture adopted (gravity); the type and extent of ventilation employed; hypoxic pulmonary vasoconstriction; and any accompanying special techniques such as deliberate hypotension. Ventilation distribution is depen...Continue Reading

Citations

Feb 26, 2020·Biomedical Physics & Engineering Express·Leonard Che FruRandall J Kimple

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