ARTERIAL GAS TENSIONS UNDER ANAESTHESIA IN TETRALOGY OF FALLOT

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Abstract
Arterial blood gases were studied at several periods during complete surgical correction of tetralogy of Fallot in 35 patients. Administration of 100 per cent oxygen during spontaneous respiration increased PaO2 in all patients. Administration of oxygen by positive pressure increased PaO2 over that of spontaneous respiration. In contrast to patients with isolated ventricular septal defect, a marked decrease in PaO2 was observed when the pleural spaces were open, despite full expansion of both lungs and continued positive pressure respiration with oxygen. It was postulated that the loss of normal negative intra-pleural pressure combined with positive pressure ventilation increased pulmonary vascular resistance sufficiently to increase right-to-left shunt. Intravenous phenylephrine altered this response in 2 of 6 patients. Some clinical implications of these observations are discussed.

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