Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942001000300001
Brazilian Journal of Anesthesiology
Scientific Article

Fatores associados com a ocorrência de hipoxemia no período pós-anestésico imediato

Factors associated to hypoxemia in the immediate postoperative period

Getúlio Rodrigues de Oliveira Filho; Jorge Hamilton Soares Garcia; Márcia Regina Ghellar; Marcos Antônio Nicolodi; Asmir Luiz Boso; Adilson José Dal Mago

http://dx.doi.org/10.1590/S0034-70942001000300001 Braz J Anesthesiol, vol.51, n3, p.185-195, 2001
PDF Português
PDF English
Downloads: 0
Views: 977

Resumo

JUSTIFICATIVA E OBJETIVOS: A hipoxemia pós-anestésica é um evento respiratório crítico que aumenta a morbidade pós-operatória. Este estudo visou identificar fatores relacionados à ocorrência de hipoxemia no período pós-operatório imediato. MÉTODO: Foram incluídos 204 pacientes admitidos à sala de recuperação pós-anestésica respirando ar ambiente. A saturação periférica da oxi-hemoglobina (SpO2), as pressões arteriais sistólica (PAS) e diastólica (PAD) e a freqüência cardíaca (FC) foram medidas a intervalos de 5 minutos desde a admissão do paciente até 20 minutos após. Escores de sedação, de dor e de adequação da ventilação foram atribuídos nos mesmos momentos. SpO2 menor que 92% foi definida como hipoxemia e indicação para oxigenioterapia. Foram registrados: idade, sexo, peso, altura, história de fumo, de DPOC e de diabete melito, SpO2 na chegada à sala de cirurgia, tipo de anestesia, região operada, duração da anestesia, uso de opióides neuro-axiais e drogas utilizadas no período peri-operatório e respectivas doses. A associação destes fatores com hipoxemia foi definida por regressão logística. RESULTADOS: Quarenta e nove pacientes (24,01%) apresentaram SpO2 menor que 92% durante o período de observação. Foram indicadores de hipoxemia [relação de chances (limites de 95% de confiança)]: idade maior que 55 anos [4,32 (1,70; 10,95)], SpO2 pré-operatória menor que 95% [7,47 (1,50;37,11)], anestesia geral com enflurano [14,53 (2,54;82,93)], hipoventilação detectada clinicamente [34,82 (11,46;105,84)]. A PAS e a FC foram significativamente mais elevadas nos pacientes hipoxêmicos. CONCLUSÕES: Existem fatores significativamente associados à ocorrência de hipoxemia pós-operatória, enquanto o uso do oxímetro de pulso permite a utilização seletiva de oxigenioterapia no período pós-anestésico imediato.

Palavras-chave

COMPLICAÇÕES: hipoxemia

Abstract

BACKGROUND AND OBJECTIVES: Postanesthetic hypoxemia is a critical respiratory event which increases postoperative morbidity. This study aimed to identify hypoxemia-related factors in the immediate postoperative period. METHODS: Participated in this study 204 patients admitted to the recovery room while breathing room air. Peripheral oxy-hemoglobin saturation (SpO2), systolic (SBP) and diastolic (DBP) blood pressure, and heart rate (HR) were measured at 5-minute intervals since admission to the recovery room until 20 minutes later. Sedation, pain and ventilation adequacy scores were attributed to patients at the same moments. Hypoxemia was defined as a SpO2 below 92% and recommended oxygen therapy. The following data were recorded for each patient: age, gender, weight, height, smoking, history of diabetes and chronic obstructive pulmonary disease (COPD), preanesthetic SpO2 at arrival in the operating room, type and duration of anesthesia, surgery site, use of neuro-axial opioids and perioperative drugs. The association of those factors to postoperative hypoxemia was defined by logistic regression. RESULTS: Forty-nine patients (24.01%) had SpO2 below 92% during the observation period. The following factors [odds ratio (95% confidence limits)] were considered hypoxemia predictors: more than 55 years old [4.32 (1.70; 10.95)], preanesthetic SpO2 lower than 95% [7.47 (1.50; 37.11)], general anesthesia with enflurane [14.53 (2.54; 82.93)], and clinically detectable hypoventilation [34.82 (11.46; 105.84)]. SBP and HR were significantly higher in hypoxemic patients. CONCLUSIONS: There are factors closely related to the incidence of postoperative hypoxemia and the use of pulse oximetry allows for selective oxygen therapy during the immediate postanesthetic period.

Keywords

COMPLICATIONS: hypoxemia

Referencias

Brown LT, Purcell GJ, Traugott FM. Hypoxaemia during postoperative recovery using continuous pulse oximetry. Anaesth Intensive Care. 1990;18:509-516.

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

Smith DC, Canning JJ, Crul JF. Pulse oximetry in the recovery room. Anaesthesia. 1989;44:345-348.

Hardeman JH, Sabol SR, Goldwasser MS. Incidence of hypoxemia in the postanesthetic recovery room in patients having undergone intravenous sedation for outpatient oral surgery. J Oral Maxillofac Surg. 1990;48:942-944.

DiBenedetto RJ, Graves SA, Gravenstein N. Pulse oximetry monitoring can change routine oxygen supplementation practices in the postanesthesia care unit. Anesth Analg. 1994;78:365-368.

Gift AG, Stanik J, Kapernick JBS. Oxygen saturation in postoperative patients at low risk for hypoxemia: is oxygen therapy needed?. Anesth Analg. 1995;80:368-372.

Rose DK, Cohen MM, Wigglesworth DF. Critical respiratory events in the postanesthesia care unit: Patient, surgical, and anesthetic factors. Anesthesiology. 1994;81:410-418.

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

Moller JT, Johannessen NW, Espersen K. Randomized evaluation of pulse oximetry in 20,802 patients: II. Perioperative events and postoperative complications. Anesthesiology. 1993;78:445-453.

Rothen HU, Sporre B, Engberg G. Airway closure, atelectasis and gas exchange during general anesthesia. Br J Anaesth. 1998;81:681-686.

Morton CP, Drummond GB. Change in chest wall dimensions on induction of anesthesia: a reappraisal. Br J Anaesth. 1994;73:135-139.

Fairley HB. Oxygen therapy for surgical patients. Am Rev Respir Dis. 1980;122:37-44.

Powell JF, Menon DK, Jones JG. The effects of hypoxaemia and recommendations for postoperative oxygen therapy. Anaesthesia. 1996;51:769-772.

Seguin P, Le Rouzo A, Tanguy M. Evidence for the need of bedside accuracy of pulse oximetry in an intensive care unit. Crit Care Med. 2000;28:703-706.

Jensen LA, Onyskiw JE, Prasad NGN. Meta-analysis of arterial oxygen saturation monitoring by pulse oximetry in adults. Heart Lung. 1998;27:387-408.

Murray RS, Raemer DB, Morris RW. Supplemental oxygen after ambulatory surgical procedures. Anesth Analg. 1988;67:967-970.

Vegfors M, Cederholm I, Lennmarken C. Should oxygen be administered after laparoscopy in healthy patients?. Acta Anaesthesiol Scand. 1988;32:350-352.

George JM, Nair L, Dhara SS. Postoperative hypoxaemia during transport and in the recovery area. Ann Acad Med Singapore. 1995;24:807-811.

Hedenstierna G, Lofstrom J. Effect of anesthesia on respiratory function after major lower extremity surgery: A comparison between bupivacaine spinal analgesia with low-dose morphine and general anesthesia. Acta Anaesthesiol Scand. 1985;29:55-60.

Hoshi K, Shima T, Andoh K. Changes in arterial oxygen tension during and after enflurane or halothane anesthesia as well as epidural analgesia. Masui. 1990;39:910-914.

Rheineck-Leyssius AT, Kalkman CJ, Trouwborst A. Influence of motivation of care providers on the incidence of postoperative hypoxaemia in the recovery room. Br J Anaesth. 1996;77:453-457.

Xue FS, Zhang GS, Liao X. The influence of surgical sites on early postoperative hypoxemia in adults undergoing elective surgery. Anesth Analg. 1999;88:213-219.

Rosenberg-Adamsen S, Lie C, Bernhard A. Effect of oxygen treatment on heart rate after abdominal surgery. Anesthesiology. 1999;90:380-384.

5dd818840e88259c6a13f286 rba Articles
Links & Downloads
2352-2291 (Electrónico) 0104-0014 (Impreso)
Braz J Anesthesiol ©2024 Todos los derechos reservados.

Braz J Anesthesiol

Share this page
Page Sections