title: Incidence of intraoperative hypoxemia in children in relation to age.
abstract: BACKGROUND
  Although respiratory problems are by far the most frequent complications of pediatric anesthesia, there are currently no reliable data on the incidence of perioperative hypoxemia in children. Most studies investigating the incidence of pediatric respiratory complications were based on self-report.
  
  
  METHODS
  We studied the incidence of intraoperative hypoxemia as well as that of pulse oximeter artifacts prospectively in 575 pediatric noncardiac surgery patients aged between 0 and 16 years operated in a tertiary pediatric university hospital. Subsequently, the incidence of intraoperative hypoxemia was determined retrospectively in 8277 patients registered in an anesthesia information management system (AIMS) of the same hospital.
  
  
  RESULTS
  In the prospective cohort, at least 1 episode of oxygen saturation (Spo2) ≤ 90% for at least 1 minute occurred in 69 of 575 cases (12%; 95% confidence interval [CI], 9%-15%). Furthermore, in 35 of 575 (6%; 95% CI, 4%-8%) cases at least 1 true hypoxemic event was observed. In total, 117 episodes of Spo2 ≤ 90% were observed in the prospective study, of which 3 of 117 could not be specified and 67 of 114 (54%; 95% CI, 42%-65%) episodes were classified as true hypoxemia. False-positive low Spo2 values were mainly caused by dislodgment of the pulse oximeter. In the retrospective analysis, Spo2 ≤ 90% and Spo2 ≤ 80% for at least 1 minute were documented in the AIMS in 18% (95% CI, 17%-19%) and 7.5% (95% CI, 7%-8%) of the cases, respectively; 31 and 10 episodes per 100 cases, respectively. The incidence of hypoxemia increased in younger age groups: Spo2 ≤ 90% for at least 1 minute occurred in 56% (95% CI, 49%-63%) of neonates (170 episodes per 100 cases).
  
  
  CONCLUSIONS
  The incidence of intraoperative hypoxemia increased with younger age, with the highest incidence in neonates. Because of the high artifact rate, unvalidated pulse oximeter data in AIMS should be interpreted with caution because only up to 65% of all hypoxemic episodes recorded during pediatric anesthesia were caused by true hypoxia.
authors.affiliation: Department 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
authors.forename: Jurgen C
authors.initials: JC
authors.lastname: de Graaff
authors.forename: Jilles B
authors.initials: JB
authors.lastname: Bijker
authors.forename: T H
authors.initials: TH
authors.lastname: Kappen
authors.forename: Leo
authors.initials: L
authors.lastname: van Wolfswinkel
authors.forename: Nicolaas P A
authors.initials: NP
authors.lastname: Zuithoff
authors.forename: Cor J
authors.initials: CJ
authors.lastname: Kalkman
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000175:diagnosis* / Q000453:epidemiology*; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007431:Intraoperative Complications / Q000175:diagnosis* / Q000453:epidemiology*; D008297:Male; D010092:Oximetry / Q000379:methods; D011446:Prospective Studies; D012189:Retrospective Studies