Post Operative Arterial Hypoxemia. Oren Erlichman, M.D UCLA Department of Anesthesiology. PACU Patient. 73 yo female with hx of depression and chronic cholesthiasis underwent GA for biliary duct leak repair. Presented to PACU in respiratory distress.
Oren Erlichman, M.D
UCLA Department of Anesthesiology
Residual inhaled anesthetics
Residual muscle relaxants
Restrictive Conditions, abdominal wall binding, abdominal distension
V/Q mismatch and Shunt
Inhibition of Hypoxic Pulmonary Vasoconstriction.
Increased Venous AdmixtureCauses of Arterial Hypoxemia in the PACU
PaO2= FIO2 (Patm-PH2O) – PCO2/R
PaO2= 0.21(760-47) – 40/0.8 = 100
PaO2= 0.21(760-47) – 80/0.8= 50
Reversal of drugs
Decrease dead space ventilation
V/Q Mismatch and Shunt
Encourage deep breathing.
Positive airway pressure
Supplemental O2, although not effective in true shunt.
Mechanical VentilationTreatmentIdentify the Underlying Cause