الفهرس 
Respiratory physiologyOnly 14 pages are availabe for public view
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Abstract
The state of anaesthesia may be considered to be intrinsically unsafe. Patients are subjected to administration of drugs which have side-effects, particularly on the cardiovascular and respiratory systems. Unconsciousness carries with it risks of airway obstruction, soiling of the lungs, and inability to detect peripheral injury.
Despite recent advances in anaesthesia and surgical care, perioperative respiratory morbidity is still a common problem. Pulmonary complications are a major source of morbidity in surgical patients, second only to cardiovascular events as a cause of perioperative death.
Acute ventilation problems are common during the perioperative period, but the use of standard monitoring during anaesthesia, as recommended by the Association of Anaesthetists of Great Britain and Ireland, should allow the detection of the three main consequences of acute ventilation problems. These include hypoxaemia, hypercapniaand changes in airway pressure.
The predominant causes of acute ventilation problems differ with the stage of anaesthesia, although most may present at any time. It is important for the anaesthetist to consider the possible causes and systematically exclude them. Of course, oxygenation must be maintained during this diagnostic. Securing and monitoring period in order to prevent morbidity and mortality.
Causes of anaesthesia-related death linked to the respiratory system may include laryngospasm, bronchospasm, aspiration, intubation injuries and pulmonary edema, ARDS and failure of the left ventricle (typically in patients with ischemic heart disease). May result from intraoperative fluid overload While Bronchospasm may be a due to an exacerbation of pre-existing asthma, perioperative pulmonary aspiration of blood or vomit, or a reaction to a drug. Pulmonary oedema or pulmonary embolus may mimic bronchospasm.
Although many claims have been made that the risk associated with anaesthesia has decreased, there is little hard supportive evidence except in relation to serious respiratory complications, where improved monitoring appears to have reduced the incidence substantially over the last three decades. Many assumptions have been based on retrospective analysis of events which ‘could have been prevented’, but numerous studies have demonstrated that the same pattern of errors, incidents and accidents continues to occur.
Inability to ventilate the lungs with the potential to cause hypoxic brain injury and death, may occur as a result of an obstruction in a tracheal tube, laryngeal mask airway or the anaesthetic breathing system. One of the major perioperative pulmonary complications that is a life threatening problem is desaturation.
The management of critical events is one of the most challenging and important tasks an anesthesiologist can face in clinical practice. For successful incidence management in anaesthesia, dynamic decision-making with the application of prepared algorithms is necessary.
The fundamental responsibility of the anesthesiologist is to maintain adequate gas exchange. In order to do this, the airway must be managed in such a way that it is almost continuously patent. Failure to maintain a patent airway for more than a few minutes results in brain damage or deaths. Thus, it is not surprising that more than 85% of all respiratory-related closed malpractice claims involve a brain-damaged or dead patient.