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Hypoxaemia during recovery from anaesthesia--an audit of children after general anaesthesia for routine elective
1Department of Anaesthesia, Royal Hospital for Sick Children, Yorkhill, Glasgow.
Insights
Post-anesthesia recovery in children can lead to hypoxemia (low oxygen saturation). Supplemental oxygen effectively reduced late-stage hypoxemia, particularly during crying and breath-holding.
Area of Science:
- Pediatric Anesthesiology
- Critical Care Medicine
- Respiratory Physiology
Background:
- Postoperative hypoxemia is a significant concern in pediatric recovery.
- Understanding the timing and triggers of hypoxemia is crucial for patient safety.
Purpose of the Study:
- To investigate the incidence and patterns of arterial oxygen saturation during recovery from general anesthesia in children.
- To identify factors associated with hypoxemia and evaluate the effect of supplemental oxygen.
Main Methods:
- Continuous pulse oximetry monitoring in 105 children (2 weeks-14 years) from anesthesia end to recovery ward discharge.
- Comparison of oxygen saturation between room air and supplemental oxygen groups.
- Analysis of hypoxemia incidence in immediate postoperative and post-waking periods.
Main Results:
- 56% of children experienced significant hypoxemia (SpO2 < 90%).
- Hypoxemia was most frequent in the immediate postoperative period and during waking.
- Tracheal intubation was linked to early hypoxemia; crying and breath-holding to late hypoxemia.
- Supplemental oxygen significantly reduced late-stage hypoxemia.
Conclusions:
- Children exhibit reduced oxygen saturation post-anesthesia compared to pre-operative values.
- Late hypoxemia in recovery is often behavioral (crying, breath-holding) and responsive to supplemental oxygen.
- Targeted oxygen administration can mitigate hypoxemia risks during pediatric recovery.
Abstract:
Arterial oxygen saturation was measured by pulse oximetry in 105 children (aged 2 weeks-14 years) during recovery from general anaesthesia. Oxygen saturation was monitored continuously from the time that anaesthesia ended in the operating theatre until the children were fit to leave the recovery ward. All children breathed room air during transfer to the recovery area; 81 children continued to breathe room air in the recovery ward while the remainder received supplementary oxygen. Fifty-six children became significantly hypoxaemic (oxygen saturation less than 90%) at some stage. Hypoxaemia occurred most frequently after termination of anaesthesia (immediate postoperative period) and then later in the recovery ward when the children began to wake up (post-waking period). The administration of 100% oxygen at the end of anaesthesia had no effect on the incidence of early hypoxaemia which was greatest in children whose trachea had been intubated. Late hypoxaemia was associated most commonly with crying and breath-holding and was reduced significantly by supplemental oxygen. The oxygen saturation of children on return to the ward was significantly lower than the pre-operative value (p less than 0.001).
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