Control of ventilation

Inhaled and intravenous anesthetics and narcotic analgesics depress the medullary respiratory center of the brain. With anesthetic induction, minute ventilation is reduced and apnea can occur as the ventilatory response to carbon dioxide is blunted or obliterated entirely. Without ventilatory support the PaCO2 of the apneic patient will rise by 2 to 3 mmHg/min, causing respiratory acidosis. Anesthetic and narcotic effects on the carotid bodies depress the ventilatory response to hypoxia and the peripheral chemoreceptor response to acidemia. The normal synergistic elevation of minute ventilation in response to hypercapnia and hypoxia is attenuated. Importantly, this phenomenon has been observed even at subanesthetic/analgesic levels of drug administration. Immediately after surgery, a comfortable resting patient can be significantly hypercapnic and hypoxemic. Narcotics, in addition to depressing the normal response to hypercapnia and hypoxia, can change the overall breathing pattern. Sighs are reduced or eliminated, the depth of the breath is shallow, cough is suppressed, and lung volumes may decrease as secretions accumulate.

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