HYPOXIA

Its
importance
in OMFS

Dr. Mukhallat
Qazi
2nd Year PG

CONTENTS
Introduction
Defi nition
Classifi cation
Hypoxia- clinical set-up
Hypoxia as a Post operative Complication
Hypoxia and Radiotherapy

INTRODUCTION

DEFINITION
An abnormally reduced oxygen supply to
tissue
A pathological condition in which the body as a whole
(generalized hypoxia) or a region of the body (regional
hypoxia) is deprived of adequate OXYGEN supply.

OXYGEN CASCADE

Air

Lungs
Hypoxic

Tissue
utilization

Blood

Anemic

Circulatory
Histotoxic

CLASSIFICATION
Inadequate
oxygenation of blood
in the lungs
Low atmospheric O2
Hypoventilation of NM origin

Pulmonary diseases

Arterio-venous Shunts

Hypoventilation due to
airway resistance or pulmonary
compliance
Abnormal alveolar
ventilation perfusion ratio
respiratory membrane diffusion

Right to left cardiac shunt

Inadequate O2
Transport to tissues

Inadequate tissue
capability to utilize O2

Heamoglobin d/o, including

anemia
General circulatory
deficiency
Localized circulatory
deficiency

Poisoning of cellular
oxidation enzymes
cellular metabolic capacity

PARAMETERS
Type
Da-vO2
Hypoxic

Anemic
N

Circulatory
N

Histotoxic

PaO2

C-O2max
N

Ca-O2 SaO2

HYPOXIC HYPOXIA
Hypoxic hypoxia is characterized by the decrease of
PaO 2 (< 60 mmHg).
EtiologyDecreased O 2 level of inspired air
Hypoventilation
Diff usion abnormality
Venous-to-arterial shunt (tetralogy of Fallot)

ANEMIC HYPOXIA
Refers to decreased quantity of Hb in the blood or
altered affi nity of Hb for oxygen.
Etiology and Mechanism
Quantity of Hb changed (Anemia)
Quality of Hb changed
ability of Hb to bind O2
Carbon monoxide (CO) poisoning- form Carboxyhemoglobin
(HbCO)
Fe3+ poisoning- form Methemoglobin (HbFe3+)

CIRCULATORY HYPOXIA
Circulatory hypoxia refers to inadequate blood fl ow
leading to inadequate oxygenation of the tissues.
Etiology

CCF
Hemorrhage
Surgical Shock
Vasospasm
Embolism

HISTOTOXIC HYPOXIA
E v e n th o ug h th e am o u nt o f ox y g e n de liv e re d to tiss u e is ad e q u ate ,
t he tis su e ce l ls can n o t m ake u s e o f th e ox y g e n s u pp lie d to t he m .
E tio l o gy Mitochondrial injury
Cyanide poisoning
Arsenide
Radiation
Bacterial toxins
Oxygen free radical

Defi ciency of B group vitamins

Coenzymes required for oxidative phosphorylation

EFFECTS OF HYPOXIA

Blood

Digestive
system

Cvs

Respirati
on

Kidney

CNS

UNCONSCIOUSNESS

Dental chair
complicatio
ns

CLINICAL MANIFESTATIONS
Unconscious person is one who is
unresponsive to sensory stimulation and
has lost protective refl exes,
along with inability to maintain patent airway

Generalized decrease in skeletal muscle tone- tongue

fall- complete or partial airway obstruction

POSTOPERATIVE HYPOXIA
High incidence- 8% have incidence of O2 Sat falling
below 90% in initial stages of post-anesthesia
Oxygenation is dependent on

Lung condition
Hb concentration
Cardiac output
O2 Sat

RADIOTHERAPY AND HYPOXIA

Tumours containing hypoxic areas- more
radioresistant
Reduction of hypoxia
Maintaining adequate Hb levels
Radiosensitizing drugs

NIMORAZOLE- Radiosensitizer

REFERENCES
Oxford textbook of Anesthesia for OMFS