List the Causes Of Hypoxia In The Operating Room & Explain How You Would Deal Wi th It?

ANSWER The key to dealing with hypoxia in the operating room is developing an algorithm ic approach to the situation. The differential diagnosis of hypoxia is broad and includes: 1. Low FIO2: Easily corrected intraoperatively by increasing FIO2. 2. Hypoventilation: Also easily corrected. 3. Shunt: Broad differential; first rule out obvious causes such as endobronchia l intubation and kinked tube, or other obvious obstruction. Consider atelectasis next, consider applying PEEP. Note that increased FIO2 will not correct shunt physiology. 4. V/Q mismatch: Normally exacerbated by anesthetic agents, as they decrease hypoxic pulmonary va soconstriction. Consider applying PEEP and using recruitment strategies. 5. Low mixed venous oxygen tension. Low mVO2 can be due to decreased cardiac out put, increased O2 consumption, or decreased hemoglobin. What To Do? There are multiple approaches to intraoperative hypoxia One strategy is as follows: A. ASSESS LIFE THREATENING SIGNS FIRST Does the patient have a pulse? Is the patient hemodynamically stable? Correct any hemodynamic abnormalities. B. PATIENT FACTORS Is the patient connected to the ventilator? Are breath sounds equal? Is wheezing present? Are there frothy secretions in the ETT? Is the ETT kinked? Correct any errors found. C . THE VENTILATION Is the ventilator on and working? If not, can a manual breath be delivered? What is the FIO2? What are the peak and plateau pressures? If the ventilator appears to be working increase the FIO2 to 1.0. Correct any er rors found. Consider bronchodilators if appropriate ie If there are wheezes D. BLEEDING Check the field: Has significant blood loss occurred? - Give blood if needed. TIP Depending upon what is found, react accordingly. 1. Increasing the FIO2 will increase oxygen content.

2. 3. 4. 5.

Adding or increasing PEEP will decrease V/Q mismatch. Suctioning the ETT can help clear airway secretions. A B2 agonist is useful for bronchospasm. Giving PRBCs will increase total hemoglobin content.

Summarized From Clinical Anesthesiology Morgan & Mikhail