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Chapter 2 - Physiology of Apnoea, Hypoxia and Airway Reflexes

from Section 1 - Airway Management: Background and Techniques

Published online by Cambridge University Press:  03 October 2020

By
Andrew D. Farmery  and
Jeremy A. Langton
Edited by
Tim Cook  and
Michael Seltz Kristensen
Tim Cook
Affiliation:
Royal United Hospital, Bath, UK
Michael Seltz Kristensen
Affiliation:
Rigshospitalet, Copenhagen University Hospital, Denmark
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Summary

The nature and origin of hypoxia is multifaceted. The prevention and treatment include optimisation of pre- and peroxygenation and the wise choice and use of neuromuscular blocking agents. Upper airway reflexes are important to anaesthetists as a clear airway allows safe ventilation of the lungs and oxygenation of the patient. Anaesthetic agents produce changes in the sensitivity of upper airway reflexes, with propofol being associated with depression of upper airway reflexes. This means that airway manipulation, and insertion of airways, including laryngeal mask airways, are more easily tolerated following induction of anaesthesia with propofol compared with other induction agents. Ageing leads to a gradual reduction in the sensitivity of upper airway reflexes. Cigarette smoking increases the sensitivity of upper airway reflexes, a change which persists for up to 2 weeks following cessation of smoking.

Keywords

Anaesthetic agentshypoxialaryngospasmupper airway reflexes
Type
Chapter
Information
Core Topics in Airway Management , pp. 9 - 21
Publisher: Cambridge University Press
Print publication year: 2020

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References

Further Reading

Benumof, JL, Dagg, R, Benumof, R. (1997). Critical hemoglobin desaturation will occur before return to an unparalyzed state following 1 mg/kg intravenous succinylcholine. Anesthesiology, 87, 979–982.CrossRefGoogle Scholar
Farmery, AD, Roe, PG. (1996). A model to describe the rate of oxyhaemoglobin desaturation during apnoea. British Journal of Anaesthesia, 76, 284–291.Google Scholar
Farmery, AD, Whiteley, JP. (2001). A mathematical model of electron transfer within the mitochondrial respiratory cytochromes. Journal of Theoretical Biology, 213, 197–207.CrossRefGoogle ScholarPubMed
Langton, JA, Murphy, PJ, Barker, P, Key, A, Smith, G. (1993). Measurement of the sensitivity of upper airway reflexes. British Journal of Anaesthesia, 70, 126–130.CrossRefGoogle ScholarPubMed
Nandwani, N, Raphael, J, Langton, JA. (1997). Effect of an upper respiratory tract infection on upper airway reactivity. British Journal of Anaesthesia, 78, 352–355.Google Scholar
Nishino, T. (2000). Physiological and pathophysiological implications of upper airway reflexes in humans. Japanese Journal of Physiology, 50, 3–14.Google Scholar
O’Driscoll, BR, Howard, LS, Davison, AG. (2008). BTS guideline for emergency oxygen use in adult patients. Thorax, 63(Suppl 6), 1–68.Google Scholar
Olsson, GL, Hallen, B. (1984). Laryngospasm during anaesthesia. A computer aided incidence study in 136,929 patients. Acta Anaesthesiologica Scandinavica, 28, 567–575.CrossRefGoogle ScholarPubMed

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