Hypoxaemia in adults in the post-anaesthesia care unit

Daley, M. Denise; Norman, Peter H.; Colmenares, M. E.; Sandler, Alan N.

doi:10.1007/bf03008452

Cited by 40 publications

(10 citation statements)

References 17 publications

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“…Perioperative hypoxemic patients were older; however, the average remained less than 65, indicating that they were not elderly. According to the literature, PACU POH has been associated with the following similar conditions: increasing age [47], obesity [49,50], ASA level [48,49], and duration of surgery [48,49]. The association of abdominal hypertension with POH in the current study may represent a mechanical effect, similar to weight, BMI, and obesity.…”

Section: Discussionsupporting

confidence: 51%

Perioperative hypoxemia is common with horizontal positioning during general anesthesia and is associated with major adverse outcomes: a retrospective study of consecutive patients

et al. 2014

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BackgroundReported perioperative pulmonary aspiration (POPA) rates have substantial variation. Perioperative hypoxemia (POH), a manifestation of POPA, has been infrequently studied beyond the PACU, for patients undergoing a diverse array of surgical procedures.MethodsConsecutive adult patients with ASA I-IV and pre-operative pulmonary stability who underwent a surgical procedure requiring general anesthesia were investigated. Using pulse oximetry, POH was documented in the operating room and during the 48 hours following PACU discharge. POPA was the presence of an acute pulmonary infiltrate with POH.ResultsThe 500 consecutive, eligible patients had operative body-positions of prone 13%, decubitus 8%, sitting 1%, and supine/lithotomy 78%, with standard practice of horizontal recumbency. POH was found in 150 (30%) patients. Post-operative stay with POH was 3.7 ± 4.7 days and without POH was 1.7 ± 2.3 days (p < 0.0001). POH rate varied from 14% to 58% among 11 of 12 operative procedure-categories. Conditions independently associated with POH (p < 0.05) were acute trauma, BMI, ASA level, glycopyrrolate administration, and duration of surgery. POPA occurred in 24 (4.8%) patients with higher mortality (8.3%), when compared to no POPA (0.2%; p = 0.0065). Post-operative stay was greater with POPA (7.7 ± 5.7 days), when compared to no POPA (2.0 ± 2.9 days; p = 0.0001). Conditions independently associated with POPA (p < 0.05) were cranial procedure, ASA level, and duration of surgery. POPA, acute trauma, duration of surgery, and inability to extubate in the OR were independently associated with post-operative stay (p < 0.05). POH, gastric dysmotility, acute trauma, cranial procedure, emergency procedure, and duration of surgery had independent correlations with post-operative length of stay (p < 0.05).ConclusionsAdult surgical patients undergoing general anesthesia with horizontal recumbency have substantial POH and POPA rates. Hospital mortality was greater with POPA and post-operative stay was increased for POH and POPA. POH rates were noteworthy for virtually all categories of operative procedures and POH and POPA were independent predictors of post-operative length of stay. A study is needed to determine if modest reverse-Trendelenburg positioning during general anesthesia has a relationship with reduced POH and POPA rates.

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Section: Discussionsupporting

confidence: 51%

Perioperative hypoxemia is common with horizontal positioning during general anesthesia and is associated with major adverse outcomes: a retrospective study of consecutive patients

et al. 2014

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“…Our primary outcome was the SpO 2 value. SpO 2 levels <95% at admission to the PACU were considered evidence of hypoxemia (Daley et al. 1991, Smith 2005, Urschitz et al.…”

Section: The Studymentioning

confidence: 99%

Comparison of two different oxygen delivery methods in the early postoperative period: randomized trial

Ayhan¹,

İyigün²,

Taştan³

et al. 2009

Journal of Advanced Nursing

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“…Early postoperative arterial hypoxaemia (EPAH) occurs during the first few hours after surgery and may be related to the type and duration of anaesthesia, type of surgical intervention and to patient age (2, 4, 5). EPAH presents in 41–55% of patients after different types of surgical intervention (1, 5, 6). For the first few hours after surgery patients reside in the post anaesthesia care unit, where routine continuous monitoring of arterial oxygenation, using pulse oximetry, enables early recognition and relevant treatment of hypoxaemia.…”

mentioning

confidence: 99%

Modelling of hypoxaemia after gynaecological laparotomy

Kjærgaard

Rees

Nielsen

et al. 2001

Acta Anaesthesiol Scand

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Oxygenation in 12 patients preoperatively, 2, 8 and 48 h after gynaecological laparotomy is described. Two patients were hypoxaemic (SaO2 <92%) 48 h postoperatively. When two different models of oxygen transport are fitted to patient data, high values of Rdiff or low values of fA2 describe the right shift in the FEO2/SaO2 curve seen in patients with oxygenation problems. These models fit patient data identically, and may be useful in quantifying postoperative hypoxaemia.

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Hypoxaemia in adults in the post-anaesthesia care unit

Cited by 40 publications

References 17 publications

Perioperative hypoxemia is common with horizontal positioning during general anesthesia and is associated with major adverse outcomes: a retrospective study of consecutive patients

Perioperative hypoxemia is common with horizontal positioning during general anesthesia and is associated with major adverse outcomes: a retrospective study of consecutive patients

Comparison of two different oxygen delivery methods in the early postoperative period: randomized trial

Modelling of hypoxaemia after gynaecological laparotomy

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