Abstract

Hypoxia in the early postoperative period can be the result of a various number of causes. Anesthesia providers must be able to quickly identify possible causes of hypoxia and apply appropriate pulmonary interventions. Potential causes of hypoxia can result from residual neuromuscular blockade from paralytic agents, respiratory depression from narcotic administration, laryngospasm, or an airway obstruction. Upper airway anatomy consists of cartilage and bone structures of the nose and mouth, followed by the soft tissue of the oropharynx and hypopharynx, and ending at the glottic opening of the vocal cords. The soft tissue of the oropharynx is prone to collapse in the anesthetized patient and may be further compromised by obesity, airway edema, obstructive sleep apnea, and external compression. In response to this risk of airway collapse, anesthesia providers must quickly be able to recognize an airway obstruction and employ airway and pulmonary interventions. Each potential cause of hypoxia necessitates a different intervention in order to optimize gas exchange. Inability to adequately recognize the source of hypoxia can result in devastating consequences leading to cyanosis and anoxic brain injury. A patient that experienced an airway obstruction in the postoperative period required an oral airway device and a two handed jaw thrust maneuver in order to improve gas exchange and ultimately reverse the hypoxia. Key indicators leading the anesthetist in identifying the airway obstruction consisted of difficult bag mask ventilation, snoring, decreasing Sp02, and cyanotic lips. Additional interventions to improve gas exchange included applying continuous positive pressure ventilation in the recovery room with a CPAP machine and raising the head of the bed. Understanding the continuation of airway management in the early postoperative period is key in preventing adverse pulmonary complications.

Author Details

Jared Hargett, DNP(c), BSN, RN; David Fort, DNP, CRNA

Sigma Membership

Non-member

Lead Author Affiliation

Samford University, Birmingham, Alabama, USA

Type

DNP Capstone Project

Format Type

Text-based Document

Study Design/Type

Case Study/Series

Research Approach

Translational Research/Evidence-based Practice

Keywords:

Hypoxia, Airway Obstruction, Sleep Apnea, Postoperative

Advisor

Fort, David

Second Advisor

Rankin, Heather

Degree

DNP

Degree Grantor

Samford University

Degree Year

2021

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.

All permission requests should be directed accordingly and not to the Sigma Repository.

All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Degree-based Submission

Acquisition

Proxy-submission

Date of Issue

2021-03-24

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