YEAR TWO: SEMESTER ONE

1. Basic Anesthesia II
2. General surgery & Thoracic emergency
Anesthesia
3. Measurements of Health and Disease
Basic Anesthesia II: 15ECTS
CONTENT AREAS
1. Airway management
2. Post anesthesia care
3. Monitoring and equipment
4. Regional anesthesia
General surgery & Thoracic emergency Anesthesia: 15ECTS

Content Areas
1. Anesthesia for GI and urology Anesthesia
2. Anesthesia for Hepato billary surgery
3. Anesthesia for Endocrine surgeries
4. Anesthesia for Thoracic emergency Surgeries
5. Anesthesia for Oncologic surgery
Airway Management
Anatomy and physiology of the
respiratory system
Presentation Layout

Explain the structure of the air ways

Explain the mechanics of breathing
Describe the lung volumes
Explain effects of hypoxia & CO2 excess
 The supra glottic air way structures
 Mouth:
 The opening of the mouth is formed by the gums and
teeth inside and the lips and the cheeks outside.

• The mouth cavity is bounded in front by the teeth and

gums,
• above by the hard and soft palates and below by the
tongue and the mucosa between the tongue and mandible.

• The tongue makes up most of the floor of the mouth,

which is bounded by the mandible and teeth.
 Cont…
The ability to achieve good mouth opening is important
for airway procedures.
The jaw-thrust maneuver, grasping the angles of the
patient’s lowers jaw and lift with both hands,
uses the sliding component of the tempro-mandibular
joint (TMJ) to move the mandible

Adequate mouth opening can facilitate the insertion of

oropharyngeal airways, supraglottic airway devices, and
laryngoscopes
 Cont…
 The palate
forms the roof of the mouth
The mucous membrane of the hard palate is closely
attached to the periosteum of the bone.
The soft palate is attached to the posterior edge of the hard
palate.
 The uvula is in the free edge of the soft palate centrally,
The front of the soft palate faces the mouth cavity.
The posterior surface is part of the nasopharynx
 Cont…
 The nose
warms, filters, and humidifies incoming air and is the
organ of smell.
It consists of the external nose and the internal nasal
cavity.
The nasal cavities are divided by the nasal septum
The roof of the nasal cavity is the cribriform plate, a thin
bone that is easily fractured, thereby resulting in
communication between the nasal and intracranial
cavities.
Prolonged nasotracheal intubation impairs drainage
through paranasal sinuses openings, causing sinusitis.
 Cont…
 The pharynx
• is a fibro muscular tube that extends from posterior aspect
of the nose at the base of the skull to the origin of
esophagus at the level of the C6.

• The soft palate divides the pharynx into a nasopharyngeal

and an oropharyngeal part.

• The nasopharynx is the part of the pharynx that lies

posterior to the nose and there is the nasopharyngeal
tonsil (adenoids).
 Cont…
• The adenoids are important to the anaesthetist for several
reasons.
They may swell and cause upper respiratory tract obstruction.
Nasotracheal intubation may be difficult if adenoids are
present or large.
Infection may result in a nasopharyngeal abscess. The
passage of a nasal or endotracheal tube could rupture such an
abscess.
Pharyngeal obstruction: This is a common problem under
anaesthesia and in the recovery period.
• The commonest cause is the tongue falling back in the
unconscious patient.
 Cont…

• The following measures should be taken to

overcome the problem.
Lift the lower jaw so that the lower incisors are in
front of the upper jaw.
Hyper-extend the head.
Insert a Guedel airway/insert a nasopharyngeal
airway.
 Place the patient in the lateral position if necessary.
If the airway obstruction still persists intubation or
insertion of a laryngeal mask
 Infraglottic structures (larynx, trachea & bronchi)
 The larynx: It is situated at the upper end of the respiratory
tract, where it extends from the epiglottis to the lower end
of the cricoid cartilage opposite to the 4th, 5th and 6th
cervical vertebrae.
• It protects lower respiratory tract from alimentary contents
and is an organ of speech
• It is composed of a number of cartilages joined together by
ligaments.
• The movement of the cartilages is controlled by muscles.
• The principal cartilages are: the thyroid, cricoid &
epiglottis.
• Paired: arytenoid, corniculate, and cuneiform
 Cont…
 Vocal cord:
These are two pearly white structures stretching from the
angle of the thyroid cartilage in front to the vocal
processes of the arytenoids behind.
 Its pale in colour because they do not have the usual
submucous tissue with blood vessels.
In adults the narrowest portion of the larynx is the
opening between the vocal cords.
In children below the age of 10 years the narrowest
portion is at the level of the cricoid cartilage.
 Cont…

 The vallecula is depressions between the median and

lateral glossoepiglottic folds that connect the lateral
edges of the epiglottis to the base of the tongue.
 The cricothyroid membrane joins the thyroid with the
adjacent cricoid cartilage.
It is close to the skin, relatively avascular, and the widest
gap between the cartilage of the larynx and trachea, so it
provides the best access for percutaneous
(cricothyrotomy) airway rescue techniques.
This technique is used in emergency condition when
intubation and ventilation
 Cont…
Vocal cord movements are controlled by 3 groups
of muscles.
The abductors, adductors, and regulators of
tension.
During inspiration the laryngeal inlet is opened,
the cords are abducted.
During expiration the cords are adducted and the
opening is closed.
The blood supply of the larynx is derived from
branches of the thyroid arteries
 Cont…
Motor innervations to these muscles and the sensory
innervations of the larynx are supplied by two branches of
the vagus nerve: The superior and recurrent laryngeal
nerves.

The superior laryngeal branch of the vagus divides into

an external (motor) nerve and internal (sensory) laryngeal
nerves that provide sensory supply to the larynx between
the epiglottis and the vocal cords.

Another branch of the vagus, the recurrent laryngeal

nerve, innervates the larynx below the vocal cords and the
trachea.
 Cont…
 Points to remember:
To avoid injury to the cords extubate the patient
during inspiration (cords abducted).
Topical analgesia (local anaesthetic) applied to
the larynx may block the sensory branches of the
superior and recurrent laryngeal nerves.
The superior laryngeal or the recurrent laryngeal
nerves may be injured during thyroid surgery.
This injury may produce varying degrees of
respiratory obstruction.
 Cont…
The trachea and bronchi:
• Trachea extends from the lower edge of the
cricoid cartilage to the carina ( c6-T5).
• It consists of C-shaped cartilage joined by
fibroelastic tissue and is closed posteriorly by the
longitudinal trachealis muscle
• The gap in the C allows room for the esophagus
to expand as swallowed food passes by.
• The trachealis muscles can contract or relax to
adjust tracheal airflow.
 Cont…
• At its inferior end, at the carina the trachea branches
into the right and left primary bronchi.

• An endotracheal tube or a tracheostomy tube which is

too long will pass from the trachea into the right main
bronchus.

• Inhaled material e.g. vomitus has a greater tendency to

gravitate into the right side of the chest.
Lower Respiratory Tract
 Lower respiratory tract
• The main bronchi divide into branches, one to each
lobe.
• These branches divide further into named branches, one
to each bronchopulmonary segment.

• The bronchi are similar in structure to the trachea except

that the cartilage is less complete

 Bronchioles: the finest bronchi. They have no cartilage.

• contain vascular, fibrous and elastic tissue.
 Lower respiratory tract …
The lungs
• The lungs are found in thoracic cage
• this cage is triangular; side walls formed by the
ribs and the intercostals muscles

• Its base formed by the diaphragm and the apex of

the thoracic cage in the neck
 Cont…
Right main bronchus Left main bronchus
Upper lobe bronchus divides into Upper lobe bronchus divides into
• Apical Superior Division
• Apical
• Anterior
• Anterior
• Posterior
• Posterior
Middle lobe bronchus divides into
Inferior Division Lingula divides into
• Medial
– Inferior
• Lateral – Superior
Lower lobe bronchus divides into Lower lobe bronchus divides into
• Apical • Apical
• Medial • Medial
• Lateral • Lateral
• Anterior • Anterior

• Posterior • Posterior
 Respiratory physiology
The mechanics of breathing
The respiratory centre
Arterial and venous blood gases
Definition of lung volume
Ventilation and perfusion
Dead space
Hypoxia  
Carbon Dioxide
 Mechanics of breathing
• The lungs are contained in the thoracic cage, which is
formed of ribs and muscles.
• The cage is triangular, its base formed by the diaphragm.
• The side walls are formed by the ribs and the intercostal
muscles.
• The apex of the thoracic cage is in the neck.
• Within the thoracic cage: two layers of pleura.
 Outer layer (visceral) pleura
 inner layer (parietal) pleura
 Mechanism cont…
• The outer layer (visceral) of the pleura is in contact
with the chest wall
• The inner layer (parietal) is in contact with the lungs.
• The space between the two layers: intrapleural space.
• The pressure in this space is negative below
atmospheric air
• The pressure in the lungs is higher, close to
atmospheric pressure.
Mechanism cont…
 The pressure changes in the chest during respiration

The intra-pleural pressure is negative.

• During inspiration -6 mmHg (-0.8kPa)
• During expiration -2.5 mmHg (-0.33kPa)
The intra-pulmonary pressure:
• During inspiration -1 mmHg (-0.13kPa)
• During expiration +1 mmHg (0.13kPa)
 Mechanism cont…
• The chest cavity enlarges during inspiration because the
muscles contract. Inspiration is therefore an active
process.
 The enlargement of the chest is in three directions:
• Antero-posteriorly: from behind forwards. This is produced by the
intercostal muscles drawing the ribs and the sternum forwards
• Laterally:or from side to side. This is produced by the
intercostal muscles drawing the lower ribs upwards and
outwards.
• Vertically or from above downwards, produced by the
contraction of the diaphragm(75% of TV).
• The distance the diaphragm moves varies from 1.5 cm to 7
cm during deep inspiration.
 Mechanism cont…
Expiration is passive; is not produced by the active
contraction of any muscles but by the relaxation of the
muscles that were contracting during inspiration.
These muscles relax or fall back into their resting
position during expiration.
The elastic recoil of the lungs brings them back also to
the resting position.
The chest cavity gets smaller, the lungs become smaller
in size and the gases are pushed out of the lungs.
 Respiratory center
This term has been applied to a group of cells in the
brain responsible for respiration.
The cells are divided into two groups, dorsal and ventral;
situated in the medulla oblongata.
These cells discharge rhythmically, which means that
they send out impulses or messages to the respiratory
muscles at a special rate
These impulses are sent out automatically.
This rate of discharge is influenced by stimuli, the
respiratory pattern meets the needs of the body.
 Respiratory center cont…
Factors affecting the respiratory centre
The control of the respiratory centre has both direct and
reflex components:
 Direct control
Oxygen (O2) lack
Carbon dioxide (CO2) excess or lack
Changes in the acid base balance of the blood
 Respiratory center cont…
 Reflex control
The chemoreceptors: a special group of cells in the neck.
• They are sensitive to changes in the chemical composition
of the blood.
 The chemoreceptors are:
• The carotid bodies found at the bifurcation of the
common carotid artery.
• The aortic bodies near the aortic arch.
• Other chemoreceptors: special cells in the brain stem,
pulmonary and coronary circulation.
 Respiratory center cont…
• The following conditions stimulate the
chemoreceptors and cause impulses to travel up
these nerves to the respiratory centre.
Oxygen lack.
Carbon dioxide excess.
An increase in the acidity of blood.
This is seen in metabolic acidosis associated with
diabetic coma.
 Respiratory center cont…
The pressor receptors: These are special cells in the
neck and the chest which are sensitive to changes in blood
pressure.

When receptors are stimulated by a rise in blood pressure

one effect is that respiration is depressed.
The main response, is on the cardiovascular system.
Sensory stimuli
The respiratory centre is stimulated by pain, movement of
joints etc.
Arterial and venous blood gases

• The function of the lungs is to maintain a normal

tension or pressure of gases in the arterial blood.

• This is achieved by ventilation.

• In this process of ventilation, fresh oxygen is brought
into the lung and excess carbon dioxide removed.
 Exchange of oxygen

• The venous blood from the tissues reaches the lungs.

• The tension or pressure of oxygen in the venous blood
(40 mmHg /5.3 kPa) is less than the pressure of oxygen
in the alveoli.
• Gases move from an area of high pressure to an area of
low pressure, so the oxygen diffuses out from the alveoli
to the venous blood oxygenating it.
• The blood thus becomes arterial.
 Arterial and venous blood cont...
 Exchange of carbon dioxide
• In addition to the exchange of oxygen, an exchange of CO2
• The venous blood arriving in the lung is rich in CO2.
• The pressure of CO2 in the venous blood is 46 mmHg (6.1
kPa).
• The alveolar pressure is 40 mmHg.
• The CO2 diffuses from the venous blood to the alveoli.
• The arterial blood leaves the lung with an oxygen tension
of 100 mmHg (13.3 kPa) and a CO2 tension of 40 mmHg
(5.3 kPa).
 Arterial and venous blood cont...
To summarise:
Arterial blood
Oxygen tension or pressure (Pa O2) 100 mmHg.
(13.3kPa)
Carbon dioxide tension (Pa CO2) 40 mmHg. (5.3 kPa)
Venous blood
Oxygen tension or pressure 40 mmHg. (5.3 kPa)
Carbon dioxide tension 46 mmHg. (6.1 kPa)
Definitions of lung volumes
 Definitions of lung volumes

 The tidal volume is the volume of gas passing into or out

of the lungs per breath (10ml/kg or approximately 500 ml in
the average adult).
 Minute volume is the volume of gas passing in or out of
the lungs per minute.
• Minute volume = Tidal volume  Respiratory rate
= 500 ml  10
= 5 litres (in the average adult)
 Dead space is the part of the tidal volume that does not take
part in ventilation (2ml/kg).
• It could be considered wasted ventilation in that it serves no
useful purpose where gaseous exchange is concerned.
 Lung volume cont…
 Alveolar ventilation is that part of the tidal volume that
actually takes part in gaseous exchange. Tidal volume =
dead space + alveolar ventilation
500 ml = 150 ml + 350 ml (in 75kg
adult).
 Vital capacity is the greatest amount of air that can be
expired after a person has breathed in as much as possible.
 Functional residual capacity (FRC) is the volume of air in
the lungs at the end of a normal expiration and is the sum of
the ERV and the RV.
• It is important to the anaesthetist because it contains a
reservoir of oxygen which can maintain blood levels of
oxygen during apnoea.
 Lung volume cont…
• It is decreased by up to 25% in the supine position and
also reduced in obesity, pregnancy and under
anaesthesia.

 Expiratory reserve volume (ERV) is the amount of air

that can be forcefully expired at the end of a normal
expiration.
 Residual volume (RV) is the amount of air remaining
in the lungs at the end of a maximum forced expiration.
 Lung volume cont…
 The gases in the alveoli pass into the blood in the
capillaries by this process of diffusion.
o The gases have to pass through three layers:
 The alveolar lining or epithelium
 Interstitial fluid
 The capillary lining or endothelium
If any of layers is thickened then diffusion is impeded.
May be thickened by disease of the lung.
The interstitial fluid may be increased in heart disease.
 Lung volume cont…
Compliance is a measure of distensibility.
Lung compliance is defined as the change in volume per
unit change in pressure.
Airway resistance denotes the measure of obstruction to
the flow of gas in the air passages.
Most of the resistance to air flow is in bronchi greater
than 2 mm in diameter.
Airway resistance is increased in asthma, emphysema,
pulmonary congestion etc.
This implies the work of breathing is increased.
 Ventilation & Perfusion
 Ventilation (V): Ventilation of the lung is not uniform.
• The lower part ventilates better than the upper. (The lower part of
the lung, due to its weight and the effect of gravity tends to be less
distended in the resting position than the upper part).
• During inspiration the lower part of the lung has a greater capacity
to fill or distend.
 Perfusion (Q): The pulmonary blood flow equals the cardiac
output.
• The pulmonary circulation is affected by gravity.
• As with ventilation, perfusion is greater at the base than at the apex
and so the lower zone has a better blood flow than the middle or
upper zone.
• The overall result is that ventilation is relatively greater than blood
flow at the apex and relatively less than blood flow at the base.
 Ventilation & Perfusion cont…
The V/Q ratio
• This expresses the relationship between the regional blood
flow and the regional ventilation in the lung.
• Ventilation/Perfusion ratios are not uniform throughout the
lung but in the healthy person ventilation and perfusion
are reasonably well matched with an overall ratio of 0.9.
• The V/Q ratio is higher at the apex and lower at the base.
• Regional ventilation perfusion ratios can be altered in
pulmonary disease.
• In pulmonary embolism there is under perfusion.
• In certain lung disease there may be under-ventilation, e.g.
pneumonia. These conditions affect gas exchange.
 Dead space

• Is part of the tidal volume that does not take part in gas
exchange. Three types of dead space will be considered:
Anatomical dead space
• This is the volume of gas that fills the respiratory
passages but which is not involved in gas exchange.
• It extends from the nostrils and mouth down to, but not
including, the alveoli.
• In the average adult this is about 150 ml (2ml/kg body
weight).
• The anatomical dead space is reduced by tracheostomy
and endotracheal intubation.
 Dead Space cont…
Physiological dead space
• This includes all the air does not take part in gas
exchange.

• It includes the anatomical dead space plus air in any

of the alveoli into which the blood does not flow and
any air in over distended alveoli where gaseous
exchange is impaired.

• Physiological dead space is increased in lung disease.

 Dead space cont…

Anaesthetic dead space

• It is that part of the tidal volume that occupies the anaesthetic
apparatus and is hence not available for gas exchange.
• The exact volume of anaesthetic dead space depends on the
• The anaesthetic dead space is the volume between the patient
and the inflow of fresh gases into the "T piece".
• In the circle absorber, it is the volume between the patient and
the junction of the inspiratory and expiratory tubing.
• If a face mask is used, the dead space is increased considerably
because part of the patient's tidal volume occupies the space
under the mask and is hence wasted.
• The use of an endotracheal tube or a tracheostomy tube reduces
the dead space.
 Carriage of oxygen in blood
Important:
• O2 is carried in solution, is only a very small quantity, 0.3 ml per 100ml
of blood (when breathing air at sea level).
• O2 is also carried in combination with the haemoglobin in the red blood
cells. 1 gm of haemoglobin can carry 1.34 ml of O2.
• The normal adult with 14.8 g of Hb/100 ml of blood will therefore carry
19 ml of O2 per 100 ml of blood. The Hb is almost fully saturated with
this 19 ml O2/100 ml blood.
• Each 100 ml of blood gives off 5 ml of O2 as it passes through the tissues
and returns to the lungs as venous blood carrying 14 ml of O 2 per 100 ml
of blood.
• When the Hb combines with O2 it is termed oxyhaemoglobin (oxyHb).
• When it gives up the O2 in the tissues it is termed reduced haemoglobin.
 Carriage of oxygen in blood cont…
The passage of oxygen from the blood to the tissues
• In the tissues the capillary blood is exposed to a low O 2 tension. The
oxygen diffuses out of the blood into the tissues. Initially the dissolved
O2 in the plasma diffuses out first.
• The O2 passes from the red blood cells (haemoglobin) into the plasma
and thence into the tissues.
• The O2 is thus unloaded into the tissues.
• There is a relationship between the O2 tension in the plasma and the O2
in combination with the haemoglobin.
• If the O2 tension is low the O2 content of the haemoglobin will be low.
If the O2 tension is high the O2 content of the haemoglobin will be high.
• The graph that shows relationship is referred to as the oxyhaemoglobin
curve
Carriage of oxygen in blood cont…

The following situations shift the oxyhaemoglobin dissociation

curve to the right and make it release oxygen more readily.
• An increase in the CO2 tension in the blood.
• An increase in the H+ ion concentration.
• An increase in temperature.
• An increase in 2,3 DPG (Diphosphoglycerate).
 2,3 DPG is found in red blood cells. It is increased in
 chronic anaemia
 hypoxia and
 thyrotoxicosis, and results in more O 2 being delivered to the tissues.
• It is decreased in polycythaemia, myxoedema and stored blood and
inhibits the release of O2 to the tissues
Hypoxia
 Hypoxia
Hypoxia means a lack of O2 in the body (tissues).
Hypoxaemia is a lack of O2 in the blood.
Cyanosis is a blueness of the tissues of the lips, tongue
and mucous membranes of the mouth.
Oxygen saturation below 90% is a reasonable definition.
It must be diagnosed quickly and treated aggressively
otherwise permanent neurological damage and cardiac
arrest may quickly follow.
There are various types of hypoxia:
Hypoxic hypoxia, Anaemic hypoxia, Stagnant hypoxia,
Histotoxic hypoxia and Diffusion hypoxia
 Hypoxic hypoxia
 This occurs if the O2 pressure in the blood is reduced for any
reason.
 less O2 carried in the blood, both in solution in the plasma and also
in combination with the Hb.
 The quantity of Hb is normal.
Causes of hypoxic hypoxia
 Not enough O2 in the inspired gases. It may also occur at a high
altitude where inspired O2 is at a reduced pressure.
 Reduced ventilation from any cause .
 Interference with diffusion between the alveoli and the blood as in
lung disease.
 Circulatory disorders, e.g. in certain congenital heart disease
where all the blood does not pass into the lungs.
 Hypoxia cont..

location Condition
Respiratory centre Drugs,Trauma, Infections, Stroke

Spinal cord Trauma

Polyneuritis
Peripheral nerves
Muscle relaxants, Myasthenia Gravis
Neuromuscular
Myopathies – especially those
junction
affecting intercostal muscles and
Muscles
diaphragm
Chest wall Fractured ribs, Flail chest
Pleural cavity Pleural effusion,Pneumothorax
Lung tissue Collapse, Pneumonia
Airway obstruction Upper –oral,laryngeal
Lower –bronchospasm
 Hypoxia cont…

Anaemic hypoxia: Here there is a reduction in the

amount of circulating Hb.
If the Hb is reduced then the oxygen carried in the blood
is reduced.
Stagnant hypoxia: occurs when the circulation is
inadequate for any reason.
The blood spends a longer time in the tissues and
therefore loses more O2 and the venous blood returning
to the lungs also has less O2..
Happens in shock, heart failure
 Hypoxia cont…

Histotoxic hypoxia: occurs when the tissues are poisoned

with drugs or chemicals, e.g. in cyanide poisoning,
oedematous tissue.
In these situations the tissues cannot accept or use the O2
brought to them by the blood.
Diffusion hypoxia: occurs at the end of an anaesthetic
where N2O/O2 is used.
The nitrous oxide passes out of the blood stream and into
the alveoli faster than the nitrogen in air passes in and this
may dilute the concentration of inspired O2.
Overcome by giving the patient 100% O2 at the end of the
anaesthetic
 Effects of oxygen lack
The central nervous system: The blood flow to the brain
is first increased, followed by oedema or swelling of the
brain and unconsciousness.
Irreversible brain damage will occur within 4 minutes if
severe hypoxia is not treated.
The respiratory system: There is an increase in respiration
in conscious patients (reflex stimulation of the respiratory
centre via the chemoreceptors)
The cardiovascular system: The PR and BP rise at first
and then fall as the hypoxia increases.
Other tissues: The liver cells are damaged.
 Effect cont…

 If a patient becomes hypoxic under anaesthesia:

Increase the inspired oxygen concentration to 100%.
Check oxygen analyser, if available, or oxygen cylinder
levels, to exclude a failed oxygen supply.
Check that ventilation is adequate:
Check end-tidal CO2, Note that oesophageal intubation
must be excluded early as this needs to be corrected
promptly.
Switch to hand ventilation to assess pulmonary
compliance and auscultate both sides of the lung to
exclude endobronchial intubation.
Check blood pressure and pulse.
 Carbon dioxide (CO2 )
 The carbon dioxide is carried in the blood in 3 forms:
In simple solution
In combination with the Hb
As bicarbonate
The greatest part of the CO2 is carried as bicarbonate
 Effects of carbon dioxide excess
Central nervous system: There is an increase in the
blood flow to the brain with a corresponding increase in
cerebral volume and raised intracranial pressure.
The sequence of events is: Headache, Nausea, Vomiting
& Coma
 CO2 cont…
Respiratory system:The respiratory centre is stimulated
both directly and reflexly via the chemoreceptors.
Severe hypercapnia produces respiratory failure.
Bohr effect: the oxyhaemoglobin dissociation curve shifts
to the right. This means more O2 is given up at tissue
level.
Cardiovascular system: CO is increased by direct effect
of CO2 and by the effect of the increase in circulating
catecholamines.
HR increases and becomes irregular, Peripheral resistance
increases & BP may rise at first, especially in the
unanaesthetised person.
 CO2 cont…
 Causes of CO2 excess (hypercapnia) in anaesthetic practice
Respiratory obstruction causing inadequate ventilation.
Inadequate ventilation, due to depression of the respiratory
centre or the action of muscle relaxants.
Faulty CO2 absorption in circle absorbers.
Accidental administration of CO2.
 CO2 cont…
Low CO2: Excessive ventilation (hyperventilation)
reduces the tension of CO2 in the blood.
The patient becomes hypocapnic (low CO2).
Hyperventilation is best avoided during GA, It can result
in cerebral vasoconstriction
It may result in foetal asphyxia during a C/ section.
Hypocapnia may delay the onset of breathing at the end
of an anaesthetic.
Hypocapnia shifts the oxyhaemoglobin dissociation
curve to the left and reduces the oxygen released to the
tissues.