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Anaes TopicsApplied cardiovascular & respiratory physiology

Anaes · Applied cardiovascular & respiratory physiology

Applied cardiovascular & respiratory physiology

Also known as Cardiac output · Oxygen delivery · Frank-Starling mechanism · Oxygen dissociation curve · Ventilation-perfusion · Functional residual capacity · Dead space · Laplace law

The applied cardiovascular and respiratory physiology is the foundation of the anaesthetic practice. The framework rests on the determinants of the cardiac output (the heart rate, the preload, the contractility, the afterload) and the Frank-Starling mechanism; the control of the arterial pressure and the systemic vascular resistance; the oxygen delivery (the cardiac output times the arterial oxygen content) and the Fick principle; the oxygen cascade and the oxyhaemoglobin dissociation curve with its 2,3-DPG and the anaesthetic shifts; the lung volumes, the compliance, the surface tension and the Laplace law; the ventilation-perfusion matching and the dead space; and the effect of the anaesthesia on the respiratory mechanics (the fall of the functional residual capacity, the atelectasis).

high11 referencesUpdated 26 July 202613 min readVerification in progress

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ANZCAFRCAABAEDAICFCAIFCA_SA

Red flags

  • The general anaesthesia falls the functional residual capacity and shifts the closing capacity upward, so the airway closure and the atelectasis develop in the dependent lung (atelectasis in about 90 per cent of anaesthetised patients; 15 to 20 per cent of basal lung collapsed). The resulting shunt causes the rapid perioperative desaturation that the preoxygenation and the PEEP only partly oppose — apnoeic oxygenation and the protective ventilation are the practical answers.
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ANZCAFRCAABAEDAICFCAIFCA_SA

Red flags

  • The general anaesthesia falls the functional residual capacity and shifts the closing capacity upward, so the airway closure and the atelectasis develop in the dependent lung (atelectasis in about 90 per cent of anaesthetised patients; 15 to 20 per cent of basal lung collapsed). The resulting shunt causes the rapid perioperative desaturation that the preoxygenation and the PEEP only partly oppose — apnoeic oxygenation and the protective ventilation are the practical answers.
The one-line answer

Every anaesthetic is a controlled assault on the circulation and the lungs. The cardiac output is stroke volume times heart rate, set by preload, contractility and afterload and governed by venous return — though pressures report the system state rather than driving flow; oxygen delivery is cardiac output times arterial oxygen content (haemoglobin and saturation do the heavy lifting, not the PaO2, and the MAP alone cannot judge it). Anaesthesia falls the functional residual capacity, opens shunt, and blunts the ventilatory drive — which is why you preoxygenate, defend the venous return at induction, and read a non-resolving hypoxaemia as shunt, not a number to chase.[1][2][9]

Meet the patient

A 72-year-old man with severe aortic stenosis arrives for a transurethral resection. The moment the propofol goes in and the positive-pressure ventilation starts, his pressure falls from 150 systolic to 70, and the plethysmograph flattens. The registrar reaches for metaraminol. The consultant is already thinking about the venous return.[1]

The two questions that decide every induction are the two this vignette turns on: how full is the venous reservoir? (the preload, which positive pressure steals) and how much oxygen is the blood actually carrying? (the cardiac output times the content, never the PaO2 alone). Hold those two questions and the physiology below stops being abstract.[1]

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References11ShowHide
  1. [1]Miller A, Kirk-Bayley J, Peck M, Wilkinson J Energy, flow and pressure in the cardiovascular system: a narrative review of how the circulation works Anaesthesia, 2026.PMID 42157570
  2. [2]Mirus M, Saugel B, Spieth PM Hemodynamic monitoring: basic principles in operation room and intensive care unit J Clin Monit Comput, 2026.PMID 41493520
  3. [3]Flick M, Aasvang EK, Eichlseder M, Klimovic A, Meidert AS, Meyhoff CS, Roth S, Steinhaus M, Sort R, Vives M, Vojnar B, Ziemann S, Krause L, Vettorazzi E, Zapf A, Kouz K, Saugel B Personalized hemodynamic management targeting preoperative baseline cardiac index in high-risk patients having major abdominal surgery: rationale and design of the international multicenter randomized PELICAN trial Trials, 2026.PMID 41904483
  4. [4]Nimmagadda U, Salem MR, Crystal GJ Preoxygenation: Physiologic Basis, Benefits, and Potential Risks Anesth Analg, 2017.PMID 28099321
  5. [5]Nakamura S, Shimizu Y, Yoshida Y, Sasaki K, Yamamoto Y Association Between Intraoperative Alveolar Dead Space Fraction and Early Extubation After Glenn and Fontan Procedures J Cardiothorac Vasc Anesth, 2026.PMID 42225457
  6. [6]Jaafar LS, Kourie CMR, El-Mallah CA, Obeid O 2,3-Diphosphoglycerate: the forgotten metabolic regulator of oxygen affinity Br J Nutr, 2025.PMID 41070558
  7. [7]Kumar A, N M Effects of inhaled anaesthetic agents on the oxygen dissociation curve: An updated discussion J Perioper Pract, 2025.PMID 39991860
  8. [8]Honing M, Martini C, van Velzen M, Niesters M, Dahan A, Boon M Cholinergic Chemotransmission and Anesthetic Drug Effects at the Carotid Bodies Molecules, 2020.PMID 33348537
  9. [9]Hedenstierna G, Edmark L Mechanisms of atelectasis in the perioperative period Best Pract Res Clin Anaesthesiol, 2010.PMID 20608554
  10. [10]Khanna AK, Banga A, Rigdon J, White BN, Cuvillier C, Ferraz J, Olsen F, Hackett L, Bansal V, Kaw R Role of continuous pulse oximetry and capnography monitoring in the prevention of postoperative respiratory failure, postoperative opioid-induced respiratory depression and adverse outcomes on hospital wards: A systematic review and meta-analysis J Clin Anesth, 2024.PMID 38184918
  11. [11]Eldesouky NA, Abo El Fetouh RM, Hafez AA, Gad A, Kamal MM The expression of CD47 and its association with 2,3-DPG levels in stored leuco-reduced blood units Transfus Clin Biol, 2019.PMID 30713045

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