Hypoxia: developments in basic science, physiology and clinical studies

Abstract

SummaryAirway management is primarily designed to avoid hypoxia, yet hypoxia remains the main ultimate cause of anaesthetic‐related death and morbidity. Understanding some of the physiology of hypoxia is therefore essential as part of a ‘holistic’ approach to airway management. Furthermore, it is strategically important that national specialist societies dedicated to airway management do not only focus upon the technical aspects of airway management, but also embrace some of the relevant scientific questions. There has been a great deal of research into causation of hypoxia and the body’s natural protective mechanisms and responses to it. This enables us to think of ways in which we might manipulate the cellular and molecular responses to confer greater protection against hypoxia‐induced tissue injury. This article reviews some of those aspects.

Sugammadex to rescue a ‘can't ventilate’ scenario in an anticipated difficult intubation: is it the answer?

“…Stefanutto et al demonstrated that a combination of remifentanil and propofol (without NBD) resulted in apnoea of sufficient duration to produce significant arterial desaturation despite adequate pre-oxygenation [29]. There is debate as to what constitutes 'adequate' preoxygenation [30,31], and modelling data suggest that even in healthy patients, critical desaturation might supervene before the time taken to reverse neuromuscular blockade [32]. Even after complete reversal of neuromuscular blockade, residual effect of opioids and induction agents may precipitate laryngospasm with any airway manipulation.…”

Oxygen supersaturated fluid using fine micro/nanobubbles

“…7 Moreover, hypoxia can affect pharmacologic metabolism, inducing physiological, cellular, and biochemical responses. [8][9][10] Thus, hypoxia is often the most crucial problem to be resolved in the treatment of various diseases, especially considering that both respiration and circulation often become impaired in progressing critical care cases, a combination that can be life threatening. The management of respiration and circulation is the most essential step in intervention.…”

Airway research: the current status and future directions

“…Some of the relevant physiology is discussed elsewhere in this issue [22], but it is clear that the upper airway at the end of surgery is not the same as that before anaesthesia induction. Residual muscle paralysis is significantly associated with a high incidence of hypoxaemia and of upper airway obstruction in the post-anaesthesia care unit [23].…”