Abstract
Continuous pulse oximetry was performed on 173 adults after general anaesthesia for elective inpatient surgery, throughout their post-anaesthesia care unit (PACU) stay. Supplemental oxygen was administered for ≥30 min after arrival and subsequently discontinued before discharge to the ward. The mean and minimum oxyhaemoglobin saturation (SpO2) after discontinuing oxygen were lower than those values achieved during oxygen administration and preoperatively (P < 0.001). At least one hypoxaemic episode (SpO2 ≤90% for ≥15 sec) occurred in 70 subjects (41%) and 45 of these had a moderatesevere episode (SpO2 ≥90% for ≤2 min or SpO2 ≤85%). The hypoxaemic episodes began 20 ±20 min (range 1–100; median 15) after discontinuing supplemental oxygen. Cyanosis was detected in only four of the 70 patients who desaturated. Factors associated with hypoxaemia were: ASA physical status class; surgical duration ≥90 min; and preoperative mean SpO2 <95%. Factors not associated with hypoxaemia were: age, sex, % ideal body weight, smoking history, preoperative minimum SpO2, premedication and type of surgery. In conclusion, after discontinuing supplemental oxygen in the PACU, hypoxaemia was common, difficult to detect clinically, and associated with ASA class, surgical duration and preoperative mean SpO2.
Résumé
Nous avons monitoré continuellement la saturation artérielle en oxygène par oxymétrie pulsée en salle de réveil chez 173 adultes hospitalisés pour une intervention chirurgicale élective. Les patients respiraient un supplément d’oxygène pendant les 30 premières minutes de leur séjour en salle de réveil. Les valeurs minimales el moyennes en oxyhémoglobine enregistrées après l’arrêt du supplément en oxygène diminuaient en dessous de celles de la période précédente el de eelles mesurées avant l’intervention chirurgicale. Au moins un épisode d’hypoxémie (SpO2 ≤90% durant au moins 15 sec) est survenu chez 70 patients (41%) el l’hypoxemie était importante (SpO2 ≤90% pendant au moins 2 min ou SpO2 ≥85%) chez 45 d’entre eux. Elle apparaissait de 1 à 100 minutes après l’arrêt du supplément en oxygène, moyenne: 20 min, écart-rype: 20 min, médiane: 15 min. Seuls quatre des patients qui désaturaient arboraient de la cyanose. Les facteurs associés à la survenue de l’hypoxémie étaient la classe ASA, un intervention chirurgicale de plus de 90 min el une SpO2 moyenne <95% avant l’intervention. L’âge, le sexe, le poids des patients de même qu’une histoire de tabagisme, la SpO2 minimale préopératoire, la prémédication et le type d’intervention chirurgicale n’influencaient pas l’incidence d’hypoxémie en salle de réveil.
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Daley, M.D., Norman, P.H., Colmenares, M.E. et al. Hypoxaemia in adults in the post-anaesthesia care unit. Can J Anaesth 38, 740–746 (1991). https://doi.org/10.1007/BF03008452
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DOI: https://doi.org/10.1007/BF03008452