Newly Published
Editorial Views  |   April 2019
Breathing Life into Pulmonary Physiology: How Age and Body Weight Impair Oxygenation
Author Notes
  • From the Department of Medicine (J.T., R.H.B.), Department of Anesthesiology and Critical Care Medicine (R.H.B.), Department of Environmental Health and Engineering (R.H.B.), and Department of Radiology (R.H.B.), Johns Hopkins University, Baltimore, Maryland.
  • Accepted for publication February 28, 2019.
    Accepted for publication February 28, 2019.×
  • Correspondence: Address correspondence to Dr. Thiboutot: Jthibou1@jhmi.edu
Article Information
Editorial Views / Respiratory System
Editorial Views   |   April 2019
Breathing Life into Pulmonary Physiology: How Age and Body Weight Impair Oxygenation
Anesthesiology Newly Published on April 29, 2019. doi:10.1097/ALN.0000000000002710
Anesthesiology Newly Published on April 29, 2019. doi:10.1097/ALN.0000000000002710
In the words of the famous H. L. Mencken, one of the most influential writers of the last century, “For every complex problem there is an answer that is clear, simple, and wrong.” Impaired arterial oxygenation is a complex problem. While one solution to impaired oxygenation is to increase the inspired oxygen, that is not necessarily the correct solution. As we parse out the various factors that cause worsening oxygenation, we get closer to understanding the reasons and thus closer to more accurate solutions.
As advances in anesthetic and surgical techniques have progressed over the past few decades, we continue to perform more surgeries on patients who previously were thought to be at too high a risk. Two determinants of worsening outcomes for patients undergoing anesthesia are old age and obesity. Traditionally, increased age is commonly associated with increasing comorbidities, and obesity is associated with obstructive sleep apnea and atelectasis, all of which portend to poorer anesthesia outcomes. Beyond these superficial assessments, there is much to be learned about what is happening physiologically during anesthesia as it relates to these determinants. In the current issue of the journal, Hedenstierna et al. studied the pathophysiologic effects of increased age and body weight on impaired oxygenation during anesthesia.1