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Intra-anesthesia hypoxia may be due to a problem with the anesthesia delivery system or a problem within the patient The following are possible causes of hypoxiaA low supply of oxygen may be due to an inadequate FiO2 mixture If the proportioning system fails to allow a proper ratio of N2O to O2 31 then a hypoxic mixture will be delivered A bobbin in the flowmeter that is stuck can fool the anesthetist into believing that more O2 is being delivered than in actuality A depleted O2 supply will also cause hypoxia as a decreased volume of O2 will be administered to the patient If the pipeline valves or cylinder valves are closed then no O2 reaches the breathing circuit The hospital should have an O2 backup supply on facility grounds for emergencies It is important to note that cylinders are full and that hoses for pipelines are hooked up correctly and function prior to anesthetizing a patient Pipeline pressures should read a minimum of 50 psig and O2 cylinders a minimum of 600 psig to assure adequate supply Leaks can occur inside the machine the CO2 absorber at hose connections in the bellows especially hanging bellows in the ventilator flowmeter and proportioner4 Broken valves allow leakage within the circuit Tests for high and low pressure leaks should be performed prior to use of the machine Do not use hoses that are damaged or frayed and have a potential for leakage Incompetent unidirectional valves may cause rebreathing of gases and a hypoxic mixture3 Leaks can be detected by low expired volume increase in ETCO2 or inadequate bellow expansion after expiration Ventilator alarms for low airway pressures indicate a leak in the ventilator Applying soapy water on connectors will result in bubbling if a leak is present1 Obstruction of flow into the circuit will prevent O2 from reaching the patient This can occur as a result of sticking flow control valves kinking of tubes or foreign bodies
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