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Severe hypoxaemia following intravenous nitroglycerine administration in an obese patient: case report.

EDITOR: The hypoxic pulmonary vasoconstriction (HPV) response is an important physiological event for preserving the ventilation/perfusion ratio [1]. It is a selfmodulatory mechanism diverting pulmonary blood flow from poorly ventilated and hypoxic to betterventilated and normoxic lung regions [2,3]. Anaesthesia accentuates decreases in functional residual capacity (FRC) in patients who are obese compared with individuals who are not obese. The decrease in FRC impairs the ability of obese patients to tolerate even brief periods of apnoea [4]. Besides these common respiratory problems in patients with obesity, any adverse condition disturbing their respiratory physiology may alter oxygen balance. Drugs that interfere with the protective mechanism of HPV may adversely affect gas exchange leading to hypoxaemia [5]. This case report describes severe desaturation episodes in a patient with obesity, hypertension and diabetes mellitus after intravenous (i.v.) nitroglycerine administration.