Influence of apnoeic oxygenation in respiratory and circulatory system under general anaesthesia

Alexander Kolettas, Vasilis Grosomanidis, Vasilis Kolettas, Paul Zarogoulidis, Kosmas Tsakiridis, Nikolaos Katsikogiannis, Theodora Tsiouda, Ioanna Kiougioumtzi, Nikolaos Machairiotis, Georgios Drylis, Georgios Kesisis, Thomas Beleveslis, Konstantinos Zarogoulidis, Alexander Kolettas, Vasilis Grosomanidis, Vasilis Kolettas, Paul Zarogoulidis, Kosmas Tsakiridis, Nikolaos Katsikogiannis, Theodora Tsiouda, Ioanna Kiougioumtzi, Nikolaos Machairiotis, Georgios Drylis, Georgios Kesisis, Thomas Beleveslis, Konstantinos Zarogoulidis

Abstract

Apnoeic oxygenation is an alternative technique of oxygenation which is recommended in the consecutive oxygen administration with varying flows (2-10 lt/min) through a catheter which is positioned over the keel of the trachea. Apnoeic oxygenation maintains for a significant period of time the oxygenation of blood in breathless conditions. This technique was first applied in 1947 by Draper, Whitehead, and Spencer and it was studied sporadically by other inventors too. However, the international literature shows few studies that have examined closely apnoeic oxygenation and its effects on Hemodynamic image and the respiratory system of the human body. Recently they have begun to arise some studies which deal with the application of this technique in several conditions such as difficult tracheal intubation, ventilation of guinea pigs in campaign conditions where the oxygen supply is limited and calculable, the application of this technique in combination with the use of extracorporeal removal of carbon dioxide (CO2). All the above indicate, the clinical use of this technique.

Keywords: Tracheal apnoeic oxygenation; hemodynamic status; hypercapnic acidosis; oxygenation indices.

Figures

Figure 1
Figure 1
Variation of PO2 in pulmonary capillary with two different approaches.
Figure 2
Figure 2
Transportation of air mass from the air vents to the cuvette.
Figure 3
Figure 3
Variation of alveolar and oral PCO2 during respiratory circle.
Figure 4
Figure 4
Hydrostatic analogue of the removal of carbon dioxide.
Figure 5
Figure 5
Changes in end expiratory carbon dioxide after sudden changes of alveolar ventilation. During the fall of PCO2 (hyperventilation) the half change comes in three minutes while during the increase in PCO2 (hypoventilation) half change comes in 16 minutes.
Figure 6
Figure 6
Changes in concentration of catecholamines in dogs’ plasma during the increase in PaCO2 (from 22 to 338 mmHg) at apnoeic oxygenation during one hour. After ventilation 10’ and return of PaCO2 in 24 mmHg, catecholamines decreased in initiate levels.
Figure 7
Figure 7
Distribution of positive pressure from the mechanical ventilation of the lungs within the thoracic cavity. Implementation of intrathoracic pressure on the heart and vascular formations. 
PΘ =Pintrathoracic, Pδτ = Ptrasnmular, PMV = Pmechanical ventilation, CΘΤ = compliance of chest wall, Cπν = lungs’ compliance.
Figure 8
Figure 8
Relation of cross section of trachea and probe blow. The remainder space has A-α cross section.

Source: PubMed

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