Everyday Oral Surgery Medicine Review: Pulmonary physiology, pathology, and management (with Dr. Andrew Jenzer)
Jan 8, 2024
In this insightful discussion, Dr. Andrew Jenzer, an oral and maxillofacial surgeon with a focus on perioperative medicine, delves into pulmonary physiology and pathology. He breaks down common pulmonary issues, explaining the intricacies of applied physiology and oxygen management. Listeners will learn about pulmonary function tests, the risks of asthma, and effective treatments for bronchospasms. Dr. Jenzer also discusses chronic obstructive pulmonary disease and essential insights on managing pulmonary embolisms, making it a must-listen for medical professionals.
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Core Lung Volumes And Ratios
- Key lung volumes (tidal, FEV1, FVC, FRC) determine ventilatory function and help classify disease as obstructive or restrictive.
- FEV1/FVC ratio ≈80% is normal; FRC ≈3 L and total lung volume ~5–6 L in healthy adults.
Oxygen Reservoirs And Metabolic Demand
- The lungs and hemoglobin are the main oxygen reservoirs; FRC is the lung reservoir to maximize before sedation.
- Tissues need ~3–5 mL O2/kg/min, so an 80 kg adult needs ~240–400 mL O2/min to avoid hypoxia.
Preoxygenate Before Induction
- Pre-oxygenate patients with tidal breathing on 100% FiO2 for 3–5 minutes or 4 deep breaths in 30 seconds to raise lung oxygen to ~90%.
- Without pre-oxygenation healthy patients desaturate in ~45–60s, but with good FRC they can last 6–8 minutes; critically ill may desaturate in 20–30s.
