Physiology and pathophysiology at high altitude: considerations for the anesthesiologist.

Millions of people live in, work in, and travel to areas of high altitude (HA). Skiers, trekkers, and mountaineers reach altitudes of 2500 m to more than 8000 m for recreation, and sudden ascents to high altitude without the benefits of acclimatization are increasingly common. HA significantly affects the human body, especially the cardiovascular and pulmonary systems, because of oxygen deprivation due to decreased ambient barometric pressure. Rapid ascents may lead to high-altitude diseases that sometimes have fatal consequences. Other factors, such as severe cold, dehydration, high winds, and intense solar radiation, increase the morbidity of patients at HA. Anesthesiologists working in or visiting areas of higher elevations should become familiar with the human physiology, altered pharmacology, and disease pattern of HA.