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Hypoxaemia: Definition and Management

The document discusses hypoxia and bronchospasm during anesthesia. Hypoxia can occur due to hypoxic gas mixtures, equipment issues like ventilator failure or breathing circuit disconnects, or patient factors such as respiratory depression, airway obstruction, or ventilation-perfusion mismatch. To manage hypoxia, the anesthesiologist should check pulse oximetry, the gas supply, breathing circuit integrity, and look for potential causes of ventilation-perfusion mismatch. Bronchospasm can occur during anesthesia and should be treated by administering 100% oxygen, manual ventilation, deepening anesthesia, and considering salbutamol, ipratropium bromide, magnesium sulfate, or epinephrine. The underlying cause of bronchosp

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Tan Hing Lee
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25 views7 pages

Hypoxaemia: Definition and Management

The document discusses hypoxia and bronchospasm during anesthesia. Hypoxia can occur due to hypoxic gas mixtures, equipment issues like ventilator failure or breathing circuit disconnects, or patient factors such as respiratory depression, airway obstruction, or ventilation-perfusion mismatch. To manage hypoxia, the anesthesiologist should check pulse oximetry, the gas supply, breathing circuit integrity, and look for potential causes of ventilation-perfusion mismatch. Bronchospasm can occur during anesthesia and should be treated by administering 100% oxygen, manual ventilation, deepening anesthesia, and considering salbutamol, ipratropium bromide, magnesium sulfate, or epinephrine. The underlying cause of bronchosp

Uploaded by

Tan Hing Lee
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd

9) Understand the definition, causes

and management of hypoxia during


anaesthesia

Hypoxaemia
Definition- Hypoxaemia refers to arterial haemaglobin desaturation
or reduced arterial oxygen tension, hypoxia is oxygen deficiency at
the tissue level.
Hypoxic
Oxygen supply, flowmeters, breathing
inspired gas
oxygen
mixture
equipment
Hypoventilation Ventilator failure, inadequate minute volume
equipment
Breathing system (obstruction, leak,
disconnection)
Tracheal tube (obstruction, oesophageal
intubation)
Patient

Respiratory depression in spontaneously


breathing patients
Obstruction in oropharynx, larynx, trachea,
bronchi.

V/Q mismatch
patient

Inadequate ventilation like endobronchial


intubation, secretions, atelectasis,

Others

Methhaemoglobinemia, malignant hyperthermia

Management:
Routine use of pulse oximetry allow early detection and
treatment of hypoxaemia. If hypoxaemia is detected,
the following plan should be determined.
1. Palpate carotid pulse, simultaneously assess the ECG
and cardiac rhythm. Treat cardiac arrest if got
inadequate cardiac output or ventricular
tachycardia/fibrillation.
2. Exclude delivery of a hypoxic gas mixture using an
oxygen analyser. Increase inspired oxygen
concentration to 100%.
3. Test the integrity of breathing system by manual
ventilation of the lungs and confirm bilateral chest
movement and breath sound. Blow down the tracheal
tube if neccesary.

4. Search clinical evidence of the


cause of V/Q mismatch with early
exclusion of pneumothorax. If
atelectasis or reduced FRC is
contributory, gentle hyperinflation
of the lungs should improve
oxygenation. Lung volume can be
maintained by applying CPAP.
[Link] the diagnosis is difficult,
measure core temprature and

10) Recognize
management of
bronchospasm
occurring during
anaesthesia

Bronchospasm (Management)
On suspecting bronchospasm

Switch to 100% oxygen

Ventilate by hand

Stop stimulation / surgery

Consider allergy / anaphylaxis; stop administration of suspected


drugs / colloid / blood products
Difficulty with
ventilation/falling
SpO2
Immediate management;
prevent hypoxia & reverse bronchoconstriction
FiO2(Fraction of Inspired Oxygen)-1.0
Switch to manuel bag ventilation
Increase concentration of volatile anesthesia (except dysflurane)
Deepening anesthesia with an intravenous anaesthetic (If
bronchospasm is related to inadequate depth)
Consider transfer to
HDU
/ ICU
Secondary
management,
provide ongoing therapy and address underlying cause

Optimise mechanical ventilation

Reconsider allergy/anaphylaxis - expose and examine the patient, review


medications

If no improvement consider pulmonary oedema/pneumothorax/pulmonary


embolus/foreign body

Consider abandoning / aborting surgery

Request & review chest X-ray


Consider transfer to a critical care area for ongoing investigations and therapy

Bronchospasm
1st line drug therapy

2nd line drug

Salbutamol
i) Metered Dose Inhaler: 68 puffs repeated as
necessary (using in-line
adaptor/barrel of 60ml
syringe with tubing or
down ETT directly)
ii) Nebulised: 5mg (1ml
0.5%) repeated as
necessary
iii) Intravenous: 250mcg
slow IV then [Link]-1

therapy
Ipratropium bromide: 0.5mg
nebulised 6 hourly
Magnesium sulphate: [Link]-1
IV over 20min
(max 2g)
Hydrocortisone: 200mg IV 6 hourly
Ketamine: Bolus 10-20mg. Infusion
[Link]-1.h-1
IN EXTREME: Epinephrine
(Adrenaline)
i)Nebulised: 5mls 1:1000
ii)Intravenous: 10mcg (0.1ml
1:10,000) to 100mcg
(1ml 1:10,000) titrated to

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