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Incidence of intraoperative hypoxemia in children in relation to age

Jurgen C de Graaff1, Jilles B Bijker, T H Kappen

  • 1Department of Pediatric Anesthesia, Wilhelmina Children's Hospital, Division of Anesthesiology, Intensive Care and Emergency Medicine, Q04.2.313, University Medical Center Utrecht, PO box 85500, 3508 GA Utrecht, the Netherlands. j.c.degraaff-2@umcutrecht.nl

Anesthesia and Analgesia
|May 21, 2013
PubMed

Insights

Pediatric anesthesia can cause hypoxemia, with true incidence data lacking. A study found significant intraoperative hypoxemia in children, especially neonates, but cautioned that many recorded events are artifacts.

Area of Science:

  • Anesthesiology
  • Pediatric Critical Care
  • Respiratory Physiology

Background:

  • Respiratory problems are common complications in pediatric anesthesia.
  • Reliable data on perioperative hypoxemia incidence in children are scarce.
  • Previous studies often relied on self-reported data for respiratory complications.

Purpose of the Study:

  • To determine the incidence of intraoperative hypoxemia in pediatric patients.
  • To assess the rate of pulse oximeter artifacts during pediatric anesthesia.
  • To analyze age-related differences in hypoxemia incidence.

Main Methods:

  • Prospective study of 575 pediatric noncardiac surgery patients (0-16 years).
  • Retrospective analysis of 8277 patients from an anesthesia information management system (AIMS).
  • Monitoring of oxygen saturation (SpO2) and identification of true hypoxemic events versus artifacts.

Main Results:

  • In the prospective cohort, 12% experienced SpO2 ≤ 90% for ≥ 1 minute, with 6% having true hypoxemia.
  • Retrospective analysis showed SpO2 ≤ 90% in 18% and SpO2 ≤ 80% in 7.5% of cases.
  • Hypoxemia incidence increased with younger age, reaching 56% in neonates (SpO2 ≤ 90%).

Conclusions:

  • Intraoperative hypoxemia is more frequent in younger children, particularly neonates.
  • A high rate of pulse oximeter artifacts (up to 35%) necessitates cautious interpretation of unvalidated AIMS data.
  • Only up to 65% of recorded hypoxemic episodes during pediatric anesthesia represent true hypoxia.
Abstract

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