1. Case 5- Hypoxia after anesthesia Group A

2. Case scenario A 37 years of age male who arrives in the post anesthetic care unit following surgical removal of his gallbladder. Surgical intervention utilizing the laparoscopic approach is successful. Patient history obtained during the preoperative phase of care showed that he was a 2 pack/day smoker and he denies taking any prescribed medications with no other medical problems. He reports that his pain is 6 on a 10-point scale. He states that he has pain in his shoulder and pressure in his abdomen. Morphine (5 mg) is ordered for the pain, and 4 mg is administered IV. At 1 hour after admission, the patient's oxygen saturations were 89% to 90%, his respiratory rate is 16 breaths per minute, and he is more difficult to arouse.

3. Discuss hypoxia and possible causes after anesthesia Hypoxia; is impaired tissue oxygenation, when Oxygen saturation is less than 95%. It is one of the most common post-operative complications that is often not recognized. Confusion can be secondary to hypoxia. Patients who are critically ill usually have increased oxygen demands; oxygen delivery is therefore fundamental to managing sick patients.

4. Causes of hypoxia  Patients at risk of hypoxia  Smokers, COPD  Reduced functional residual capacity: Elderly, Obesity, Diabetes, General Anesthetic  Surgical pathology: Restricted ventilation, systemic inflammatory response syndrome  Other causes: Post-op Sedation, Hypothermia, Fluid overload, Pulmonary oedema, Bronchopneumonia, Lobar pneumonia, Pre-existent COPD, Atelectasis with hypoventilation, Pulmonary embolism, ARDS.

5. Was this patient hypoxemic??!  YES

6. Discuss hemoglobin oxygen dissociation curve  It Describes the relation between the partial pressure of oxygen (x axis) and the oxygen saturation (y axis).  multiple factors can affect the affinity of Hb for oxygen, thus causing the curve to shift to the left (increased oxygen affinity) or to the right (decreased O2 affinity)  https://www.youtube.com/watch?v=HYbvwMSzqdY&feature=youtu.be https://www.youtube.com/watch?v=HYbvwMSzqdY&feature=youtu.be

7. Discuss clinical assessments and management of postoperative hypoxia  The primary assessment: identify the life-threatening problems by rapid, targeted clinical examination of airway, breathing, circulation and disability.  Asses the blood saturation by: Pulse oximetry  Asses the peripheral pulse rate.  if the patient was hypoxic the next step is to Resuscitate immediately.  Secondary assessment: aimed at gathering more information.  Assess Problem: by Arterial blood gas analysis and Chest X-Ray  Treat The Cause if possible or give supportive therapy with 100% supplemental oxygen, ventilation and in sever cases intubation.  Tertiary assessment:. This is a review of the clinical process, identifying strengths and weaknesses, aimed at improving future care.

8. Discuss effect of smoking on respiratory system  irritation of the trachea and larynx  reduced lung function and breathlessness due to swelling and narrowing of the lung airways and excess mucus in the lung passages  impairment of the lungs’ clearance system, leading to the build-up of poisonous substances, which results in lung irritation and damage  increased risk of lung infection and symptoms such as coughing and wheezing  permanent damage to the air sacs of the lungs.

9. Does the patient's history of smoking may be the cause of the respiratory insufficiency? ■ Yes  Smoking is risk factor for respiratory insufficiency  Smoking can cause COPD which lead to respiratory insufficiency

10. References https://ptolemy.library.utoronto.ca/sites/default/files/reviews/2012/April%20- %20Hypoxia.pdf http://www.hopkinsmedicine.org/healthlibrary/conditions/respiratory_disorders /smoking_and_respiratory_diseases_85,P01331/ http://www.healthline.com/health/acute-respiratory-failure#Overview1

11. Thank you,,