Time Course of Postoperative Hypoxaemia

Rosenberg, Jacob; T, Ullstad; Rasmussen, J. H.; Hjorne, Flemming P.; Poulson, Niels J.; Goldman, Michael

doi:10.1097/00132586-199502000-00022

Cited by 21 publications

(31 citation statements)

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“…After 70 hours, no incidents of hypoxaemia were observed in any patient. The above results confirm the observations of Rosenberg [10,11], Pedersen [13] and Reeder [12], which indicate that postoperative hypoxaemia does not have to include the immediate postoperative period and can develop later, even up to 7 days after surgery, according to some authors [9,10,13,16]. Lower incidences of hypoxaemia in the immediate postoperative period are likely to result from favourable effects of mechanical ventilation, lung expansion and the use of concentrations of a respiratory mixture of oxygen higher than 21%.…”

Section: Discussionsupporting

confidence: 87%

“…In patients receiving analgesic treatment using an epidural catheter, i.e., those who did not receive opioids, the highest number of hypoxaemia occurrences was found on the second postoperative day when their number reached a plateau and remained at the same level until the end of observation. In both groups, the number of nocturnal incidents was higher than day incidents, constituting 57% of all incidents noted; however, the difference was not as significant as the one reported by Rosenberg [10,11,13].…”

Section: Discussioncontrasting

confidence: 52%

“…Because desaturation incidents occurred in both study groups in the same periods of spontaneous breathing and with a similar frequency, it seems that their occurrence is not associated with opioids, the administration of which is considered to be the risk factor for developing postoperative hypoxaemia [5,9,10,17]. Therefore, it cannot be explicitly recognised that epidural anaesthesia reduces the incidence of hypoxaemia episodes.…”

Section: Discussionmentioning

confidence: 99%

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Czy znieczulenie zewnątrzoponowe zmniejsza częstość incydentów desaturacji w okresie pooperacyjnym u chorych operowanych z powodu tętniaka aorty brzusznej?

Dylczyk-Sommer

Owczuk²,

Wujtewicz³

et al. 2015

Anaesthesiol Intensive Ther

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Background: Postoperative desaturation can lead to severe hypoxaemia and even tissue hypoxia, followed by cardiological and neurological complications. Opioid usage is the one of the most important risk factors of postoperative desaturation and hypoxemia. Epidural anaesthesia is recommended for vascular surgery for many reasons; the reduction or elimination of opioid doses is one reason. The aims of the study were to evaluate the incidence of desaturation episodes in patients after surgical procedures with abdominal aortic clamping, to determine whether the episodes in question lead to clinical symptoms of hypoxia and to determine whether epidural anaesthesia decreases the incidence of desaturation episodes. Methods: After abdominal aortic repair, 58 patients who did not have any respiratory disease, were classified as ASA II−III, and were aged from 46 to 80 years were observed in the ICU during spontaneous breathing with oxygen supplementation. Non-invasive O 2 saturation measurements were taken continuously, and all desaturation incidents (defined as O 2 saturation ≤ 93% for 4 min) were noted. Patients were divided into two equal groups: A -epidural blockade used after the operation for pain relief and B -intravenous opioids administered during the postoperative period. We evaluated and compared the desaturation frequency during the postoperative period. Results: Desaturation was observed among 26 (89%) patients in group A and 27 (93%) patients in group B. There were no statistical differences among the groups (P = 1.0). Severe hypoxemia (O 2 saturation ≤ 84%) was observed among 7 (24.1%) patients in group A and 10 patients in group B (34.5%) (P = 0.38). Clinical symptoms of hypoxia were similar in both groups (P = 1.0). Conclusions: Epidural anaesthesia did not protect against postoperative desaturation. Though oxygen therapy was used, desaturation was observed in approximately 90% of patients.

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Section: Discussionsupporting

confidence: 87%

Section: Discussioncontrasting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

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Czy znieczulenie zewnątrzoponowe zmniejsza częstość incydentów desaturacji w okresie pooperacyjnym u chorych operowanych z powodu tętniaka aorty brzusznej?

Dylczyk-Sommer

Owczuk²,

Wujtewicz³

et al. 2015

Anaesthesiol Intensive Ther

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“…This is usually followed by a profound increase in the amount and density of REM sleep (REM sleep rebound) during recovery nights 3 to 5. 44,[57][58][59] The episodes of sleep disordered breathing and hypoxemia are usually worse during REM sleep due to hypotonia and unstable breathing. REM sleep is also associated with increased sympathetic discharge leading to tachycardia, hemodynamic instability, and myocardial ischemia.…”

Section: Sleep In America 2005mentioning

confidence: 99%

Obstructive Sleep Apnea Syndrome and Perioperative Complications: A Systematic Review of the Literature

Vasu

Grewal

Doghramji

2012

Journal of Clinical Sleep Medicine

217

147

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Obstructive sleep apnea syndrome (OSAS) is a common sleep related breathing disorder. Its prevalence is estimated to be between 2% and 25% in the general population. However, the prevalence of sleep apnea is much higher in patients undergoing elective surgery. Sedation and anesthesia have been shown to increase the upper airway collapsibility and therefore increasing the risk of having postoperative complications in these patients. Furthermore, the majority of patients with sleep apnea are undiagnosed and therefore are at risk during the perioperative period. It is important to identify these patients so that appropriate actions can be taken in a timely fashion. In this review article, we will discuss the epidemiology of sleep apnea in the surgical population. We will also discuss why these patients are at a higher risk of having postoperative complications, with the special emphasis on the role of anesthesia, opioids, sedation, and the phenomenon of REM sleep rebound. We will also review how to identify these patients preoperatively and the steps that can be taken for their perioperative management. OSAS has been shown to be associated with various healthrelated consequences, including increased rate of motor vehicle accidents, hypertension, diabetes mellitus, congestive heart failure, stroke, and all-cause mortality. [1][2][3][4][5][6][7][8][9] Recently, numerous studies have demonstrated that surgical patients with sleep apnea are at increased risk of having perioperative complications, including hypoxemia, pneumonia, diffi cult intubation, myocardial infarction, pulmonary embolism, atelectasis, cardiac arrhythmias, and unanticipated admission to the ICU. The majority of patients with OSA are undiagnosed upon admission and are at risk during the perioperative period, presumably due to their underlying sleep apnea. Therefore, it is very important to identify these patients preoperatively so that one can initiate appropriate perioperative measures. EpidemiologyOSAS is an extremely common sleep related breathing disorder, and its prevalence has been increasing throughout the world because of obesity and increasing age of the general population. Its prevalence is between 2% and 25% in the general population, depending upon how sleep apnea is defi ned. In an epidemiological study, Young et al. noted that the prevalence of sleep apnea, defi ned as apnea-hypopnea index (AHI) ≥ 5/h was 9% for women and 24% for men. 10 However, the prevalence of OSAS (defi ned as AHI ≥ 5/h and daytime sleepiness) was 2% in women and 4% in men. 10 The National Sleep Foundation (NSF) Sleep in America 2005Poll found that 1 in 4 Americans are at high risk of having sleep apnea based on the Berlin Questionnaire. 11 The prevalence of sleep apnea is much higher in surgical patients and depends on the type of surgery. In the bariatric surgery population, the prevalence of sleep apnea has been found to be > 70%. 12,13 It is the standard of care for these patients to get a formal sleep evaluation prior to undergoing the bariatric surgery. Howev...

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“…54 Hypoxemia is a major problem for patients with OSA in the postoperative period and hypoxemic episodes have been reported to occur mostly between the postoperative nights two to five. 55 Up to 40% of patients undergoing abdominal or thoracic surgery may experience postoperative hypoxemia. 56 In particular, surgical patients with OSA are at high risk of having postoperative complications.…”

mentioning

confidence: 99%

Obstructive Sleep Apnea and Oxygen Therapy: A Systematic Review of the Literature and Meta-Analysis

Mehta

Vasu

Phillips

et al. 2013

Journal of Clinical Sleep Medicine

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Time Course of Postoperative Hypoxaemia

Cited by 21 publications

References 0 publications

Czy znieczulenie zewnątrzoponowe zmniejsza częstość incydentów desaturacji w okresie pooperacyjnym u chorych operowanych z powodu tętniaka aorty brzusznej?

Czy znieczulenie zewnątrzoponowe zmniejsza częstość incydentów desaturacji w okresie pooperacyjnym u chorych operowanych z powodu tętniaka aorty brzusznej?

Obstructive Sleep Apnea Syndrome and Perioperative Complications: A Systematic Review of the Literature

Obstructive Sleep Apnea and Oxygen Therapy: A Systematic Review of the Literature and Meta-Analysis

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