[The use of pulse oximetry in detecting disorders of the arterial oxygen status in the immediate postoperative phase exemplified by combination anesthesia with isoflurane].
Adequate respiratory monitoring should immediately indicate deteriorations of arterial oxygen status, e.g. hypoxia (paO2-decrease [mmHg]), hypoxaemia (caO2-decrease [ml/dl]) and hypoxygenation (saO2-decrease [%]). These alterations have been detected in the early postanaesthetic period only by the classical clinical criterias cyanosis and tachycardia. Therefore, O2-application often is recommended for the first 10 min postoperatively. Nevertheless oxygen therapy as well as discharge from the recovery room both are dependent on the anaesthetist's judgement. It was the aim of this study to evaluate incidence and criterias of postanaesthetic hypoxygenation following balanced anaesthesia with isoflurane and to estimate both the actually most valid parameter (psO2) and the monitoring of choice (pulse oximetry). Postoperative hypoxygenation (psO2 less than 90%) occurred in 36% within the total of 50 patients. A correlation between hypoxygenation and sex, age, smoking habits and ASA-classification (groups I and II) could not be detected. In conclusion postanaesthetic hypoxygenation must be considered as being influenced by a widespread number of different factors. It's occurrence therefore, seems to be unpredictable. Hypoxygenation can easily be avoided by application of O2 (31/min) over at least 40 min. Cyanosis and tachycardia are not suitable for recognition of hypoxaemia caused by periodically occurring hypoxygenations. With respect to the limitations of the method (measurement of arterial O2-saturation in peripheral circulation using pulse wave as an inflow indicator of arterial blood into the capillary bed; increased Hb-derivative concentrations, e.g. COHb), pulse oximetry for estimation of partial O2-saturation (psO2) seems to be the respiratory monitoring of choice in the early postoperative period. In that sense it is superior to pO2 but inferior to saO2 and caO2.
Mertzlufft
F O
FO
Klinik für Anästhesiologie, Johannes-Gutenberg-Universität Mainz.
Brandt
L
L
Nick
D
D
D000328:Adult; D000768:Anesthesia, General; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000175:diagnosis*; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D007530:Isoflurane; D007796:Laminectomy; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010092:Oximetry; D011183:Postoperative Complications / Q000175:diagnosis*; D012307:Risk Factors
D007530:Isoflurane
Der Einsatz der Pulsoxymetrie zur Erkennung von Störungen des arteriellen Sauerstoff-Status in der unmittelbar postoperativen Phase am Beispiel von Kombinationsnarkosen mit Isofluran.