AANA Journal Course: Update for Nurse Anesthetists-Optimizing Mechanical Ventilation During General Anesthesia

Optimal mechanical ventilatory support is a vital component of intraoperative anesthesia care, lung protection, and minimizing postoperative pulmonary sequela. Although concepts surrounding ventilation can be multifaceted and ambiguous, a pragmatic approach coupled with contemporary evidence and skilled assessments will facilitate ideal intraoperative management. Effective mechanical ventilation is dependent on obtaining the best pulmonary mechanics, including compliance, resistance, and gas exchange. Optimally titrated positive end-expiratory pressure is the foundation for ideal pulmonary mechanics, preventing ventilator-induced lung injury, and minimizing postoperative pulmonary complications. A knowledgeable application of pressure support ventilation can offer additional advantages during general anesthesia and emergence, providing synchronized ventilation and augmenting the patient's own respiratory efforts. These concepts, coupled with clinical expertise, will offer insight into the methods, tools, and techniques available to modern anesthetists.