30

Clinical Sedation in Dentistry

respiration rate. This allows the calculation of the minute

volume which can be expressed as:
MINUTE VOLUME = TIDAL VOLUME RESPIRATION RATE
A simple calculation (450ml 12) shows this to be just over
5 litres per minute in a healthy adult, although allowances
need to be made for size and other factors. Of that volume
only two-thirds ever reaches the alveoli of the lungs where
it is available for gas transfer. The remaining part, occupying
the nose, pharynx, trachea and bronchi, which is not
available for gas transfer, is known as the dead space and
is normally 150ml. The dead space increases with chronic
lung disease, e.g. bronchitis, asthma. The relative volumes
can be seen in Table 2.2 and are illustrated graphically in
Figure 2.10.
Lung entry
The effect of a gas (i.e. its degree of activity or depth of
sedation) depends on several factors but the speed of onset
is principally dependent on its partial pressure at the site of

Table 2.2

Lung volumes

Characteristic

Volume

Tidal volume normal breath

450 500 ml

Vital capacity maximum inspiration to expiration

3.0 to 5.0 litres

Residual volume amount left after forced expiration

1.5 litres

Total lung capacity The sum of the vital capacity

and the residual volume
Inspiratory reserve volume air which an individual
can force into the lungs during breathing
(approximately)

3 litres

Expiratory reserve volume The amount of air that

can be forced out of the lungs by an individual after a
normal breath

1.5 litres

Functional residual capacity The amount of air

which remains after quiet expiration (approximately)

3 litres