Incidence of early postanesthetic hypoxemia in the postanesthetic care unit and related factors

  • Iván Fernando Quintero-Cifuentes Anaesthesiology Department, Fundación Valle del Lili, Cali, Colombia.
  • Daniela Pérez-López Biomedical Research Centre, Universidad Icesi, Cali, Colombia.
  • Diego Ferney Victoria-Cuellar Biomedical Research Centre, Universidad Icesi, Cali, Colombia.
  • Natalia Satizábal-Padridín a. Anaesthesiology Department, Fundación Valle del Lili, Cali, Colombia. b. Clinical Research Centre (CIC), Fundación Valle del Lili, Cali, Colombia.
  • Einar Sten Billefals-Vallejo a. Anaesthesiology Department, Fundación Valle del Lili, Cali, Colombia. b. Biomedical Research Centre, Universidad Icesi, Cali, Colombia.
  • Darío Alberto Castaño-Ramírez Clinical Research Centre (CIC), Fundación Valle del Lili, Cali, Colombia.
  • Luis David Beltrán-Osorio Fundación Valle del Lili, Cali, Colombia.
Keywords: Hypoxemia, Postoperative Period, Postoperative Care, Anesthesia Recovery Period, Observational Study

Abstract

Introduction:

Postoperative hypoxemia is a frequent adverse event in the postanesthetic care unit (PACU). Incidence varies substantially, between 14% and 80%, depending on the complexity of the referral center and the characteristics of the population, with the potential for severe and even fatal outcomes.

Objective:

To determine the incidence of early postoperative hypoxemia (EPH) in the PACU and identify related clinical factors.

Materials and methods:

Cross-sectional analytical observational study in adult patients taken to the PACU following surgical procedures under general or neuroaxial anesthesia, between April and May 2017. Peripheral arterial oxygen saturation was recorded on admission to the PACU. Factors associated with the development of EPH were evaluated using simple logistic and multivariate regression step by step.

Results:

Overall, 365 patients were included. Median age was 49 years (interquartile range 36-63 years), half of them were women (55.3%), and 7.4% had lung disease. Of the total number of patients, 60 developed EPH, for an incidence of 16%. Age, a history of obstructive sleep apnea syndrome (OSAS), and anesthesia time were statistically significant associated factors. The type of anesthesia, the type of surgery, and the surgical site were not significant associated factors.

Conclusion:

It is recommended to identify elderly patients, a history of OSAS, and potential exposure to prolonged anesthesia time in order to implement strategies designed to reduce the risk of EPH.

References

1. Benavides A, Prieto F, Torres M, et al. Evidence-based clinical practice manual: Postoperative controls. Rev Colomb Anestesiol 2015;43:20-31.

2. Faraj JH, Vegesna ARR, Mudali IN, et al. Survey and management of anaesthesia related complications in PACU. Qatar Med J 2012;2012:64-70.

3. Canet J. Early postoperative arterial oxygen desaturation: determining factors and response to oxygen therapy. Anesth Analg 1989;69:207-212.

4. Díaz O. Postoperative hypoxemia: differential diagnosis and management. Medwave 2001;1:e1128.

5. Wang Y, Xue S, Zhu H. Risk factors for postoperative hypoxemia in patients undergoing Stanford A aortic dissection surgery. J Cardiothorac Surg 2013;8:1-7.

6. Moller JT, Wittrup M, Johansen SH. Hypoxemia in the postanesthesia care unit: an observer study. Anesthesiology 1990;73: 890-895.

7. Oliveira Filho GR, Garcia JHS, Ghellar MR. Factors associated to hypoxemia in the immediate postoperative period. Rev Bras Anestesiol 2001;51:185-195.

8. Smith T, Pinnock P, Lin T. Smith T, Colin P, Ted L. Postoperative management. Fundamentals of Anaesthesia Third edit.Cambridge University Press 2008, Cambridge:2009;57-76.

9. Mejía G. Desaturación arterial de oxígeno en el postoperatorio tadio determinada por oximetria de pulso. In: Trabajo presentado en el XIX Congreso Colombiano de Anestesiología. Manizales, Colombia; 1991. p. 37-48.

10. Craig DB, Frcp C. Postoperative recovery of pulmonary function. Anesth Analg 1981;60:46-52.

11. Martínez G, Cruz P. Atelectasis in general anesthesia and alveolar recruitment strategies. Rev Esp Anestesiol Reanim 2008;55:493-503.

12. Klingstedt C, Hedenstierna G, Lundquist H, et al. The influence of body position and differential ventilation on lung dimensions and atelectasis formation in anaesthetized man. Acta Anaesthesiol Scand 1990;34:315-322.

13. Maity A, Maulik S, Saha D, et al. Detection of hypoxia in the early postoperative period. Anesth Essays Res 2012;6:34-37.

14. Dunham CM, Hileman BM, Hutchinson AE, et al. Perioperative hypoxemia is common with horizontal positioning during general anesthesia and is associated with major adverse outcomes: a retrospective study of consecutive patients. BMC Anesthesiol 2014;14:1-10.

15. Russell GB, Graybeal JM. Hypoxemic episodes of patients in a postanesthesia care unit. Chest 1993;104:899-903.

16. Knudsen J. Duration of hypoxaemia after uncomplicated upper abdominal and thoraco-abdominal operations. Anaesthesia 1970;25:372-377.

17. Hara N, Furukawa T, Yoshida T, et al. Relationship between postoperative hypoxemia and the operative site. Jpn J Surg 1981;11:317-322.

18. Murphy GS, Szoko JW, Avram MJ, et al. Residual neuromuscular block in the elderly. Anesthesiology 2015;123:1322-1336.

19. Smith DC, CrulJF. Early postoperative hypoxia during transport. Br J Anaesth 1988;61:625-627.

20. Denise M, Norman PH, Colmenares ME, et al. Hypoxaemia in adults in the post-anaesthesia care unit. Can J Anaesth 1991;38:740-746.

21. Siler JN, Rosenberg H, Mull TD, et al. Hypoxemia after upper abdominal surgery: comparison of venous admixture and ventilation/perfusion inequality components, using a digital computer. Ann Surg 1974;179:149-155.

22. Rojas-Pérez EM. Factors that affect pulse oximetry. Rev Mex Anestesiol 2006;29:S193-S198.

23. Khalil MA. Smoking as a risk factor for intraoperative hypoxemia during one lung ventilation. J Anesth 2013;27:550-556.

24. Xará D, Santos A, Abelha F. Adverse respiratory events in a post-anesthesia care unit. Arch Bronconeumol 2015;51:69-75.

25. Murphy GS, Szokol JW, Marymont JH, et al. Residual neuromuscular blockade and critical respiratory events in the postanesthesia care unit. Anesth Analg 2008;107:130-137.
How to Cite
1.
Quintero-Cifuentes IF, Pérez-López D, Victoria-Cuellar DF, Satizábal-Padridín N, Billefals-Vallejo ES, Castaño-Ramírez DA, Beltrán-Osorio LD. Incidence of early postanesthetic hypoxemia in the postanesthetic care unit and related factors. Colomb. J. Anesthesiol. [Internet]. 2018 Oct. 1 [cited 2022 Oct. 3];46(4):309-16. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/400

Downloads

Download data is not yet available.
Published
2018-10-01
How to Cite
1.
Quintero-Cifuentes IF, Pérez-López D, Victoria-Cuellar DF, Satizábal-Padridín N, Billefals-Vallejo ES, Castaño-Ramírez DA, Beltrán-Osorio LD. Incidence of early postanesthetic hypoxemia in the postanesthetic care unit and related factors. Colomb. J. Anesthesiol. [Internet]. 2018 Oct. 1 [cited 2022 Oct. 3];46(4):309-16. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/400
Section
Original