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Continuing Education in Anaesthesia, Critical Care & Pain Advance Access published online on June 24, 2009
Continuing Education in Anaesthesia, Critical Care & Pain, doi:10.1093/bjaceaccp/mkp018
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© The Author [2009]. Published by Oxford University Press on behalf of The Board of Directors of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org

Physiology of apnoea and the benefits of preoxygenation

R Sirian, FRCA
Specialist Registrar in Anaesthesia
Queens Medical Centre
Derby Road
Nottingham
UK

Jonathan Wills, MA FRCA
Consultant Anaesthetist
Department of Anaesthesia
Southmead Hospital
North Bristol Trust
Southmead Road
Westbury-on-Trym
Bristol BS10 5NB
UK
Tel: +44 1179505050
Fax: +44 1179595075
E-mail: jonathan.wills@nbt.nhs.uk

The first 150 words of the full text of this article appear below.


Key points

Knowledge of those patients who will suffer early arterial desaturation during apnoea can allow careful preparation and early intervention. Examples include the critically ill, obese, parturient, and the paediatric patients.
Preoxygenation is a simple safety procedure, which can have a significant influence on time to desaturation.
During apnoea, arterial oxygen saturation remains high until almost all of the body's reserves of oxygen have been used. Arterial oximetry is not a good predictor of impending hypoxaemia.
When severe hypoxaemia develops, the arterial oxygen saturation decreases rapidly, at a rate close to 30% min–1.
Increasing the oxygen fraction applied to the airway from 90% to 100% more than doubles the survival duration of open-airway apnoea.
It is important to maintain a patent airway if a patient is apnoeic, even if no ventilation is being attempted.
Time to critical hypoxaemia for an apnoeic obese patient is extended by preoxygenation in . . . [Full Text of this Article]

 

   Apnoea and the benefits of preoxygenation
 
What happens during apnoea?

Functional residual capacity

Preoxygenation

Maintenance of a patent airway

Re-oxygenation

Haemoglobin concentration

Metabolic rate

Physiological shunt and dead space


   Clinically relevant situations
 
Obesity

Pregnancy

Critical illness

Rapid sequence induction of anaesthesia

Children


   Conclusion
 

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