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Karcz M, Papadakos PJ. Respiratory complications in the postanesthesia care unit: A review of pathophysiological mechanisms. Can J Respir Ther. 2013;49(4):21-9
Karcz, M., & Papadakos, P. J. (2013). Respiratory complications in the postanesthesia care unit: A review of pathophysiological mechanisms. Canadian journal of respiratory therapy : CJRT = Revue canadienne de la therapie respiratoire : RCTR, 49(4), 21-9.
Karcz, Marcin, and Papadakos, Peter J. "Respiratory complications in the postanesthesia care unit: A review of pathophysiological mechanisms." Canadian journal of respiratory therapy : CJRT = Revue canadienne de la therapie respiratoire : RCTR vol. 49,4 (2013): 21-9.
Karcz M, Papadakos PJ. Respiratory complications in the postanesthesia care unit: A review of pathophysiological mechanisms. Can J Respir Ther. 2013;49(4):21-9. PMID: 26078599; PMCID: PMC4456822.
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Can J Respir Ther. 2013;49(4):21-9.

Respiratory complications in the postanesthesia care unit: A review of pathophysiological mechanisms.

Canadian journal of respiratory therapy : CJRT = Revue canadienne de la therapie respiratoire : RCTR

Marcin Karcz, Peter J Papadakos

Affiliations

  1. Department of Anesthesiology, University of Rochester, Rochester, New York, USA.

PMID: 26078599 PMCID: PMC4456822

Abstract

General anesthesia and mechanical ventilation impair pulmonary function, even in normal individuals, and result in decreased oxygenation in the postanesthesia period. They also cause a reduction in functional residual capacity of up to 50% of the preanesthesia value. It has been shown that pulmonary atelectasis is a common finding in anesthetized individuals because it occurs in 85% to 90% of healthy adults. Furthermore, there is substantial evidence that atelectasis, in combination with alveolar hypoventilation and ventilation-perfusion mismatch, is the core mechanism responsible for postoperative hypoxemic events in the majority of patients in the postanesthesia care unit (PACU). Many concomitant factors also must be considered, such as respiratory depression from the type and anatomical site of surgery altering lung mechanics, the consequences of hemodynamic impairment and the residual effects of anesthetic drugs, most notably residual neuromuscular blockade. The appropriate use of anesthetic and analgesic techniques, when combined with meticulous postoperative care, clearly influences pulmonary outcomes in the PACU. The present review emphasizes the major pathophysiological mechanisms and treatment strategies of critical respiratory events in the PACU to provide health care workers with the knowledge needed to prevent such potentially adverse outcomes from occurring.

Keywords: Alveolar hypoventilation; Atelectasis; Postanesthesia care unit; Pulmonary shunt; Respiratory complications; Ventilation-perfusion mismatch

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