Monitoring respiration and oxygen saturation in patients during the first night after elective bariatric surgery: A cohort study

Sune Forsberg,Frederic Bouvier,Jan G. Jakobsson,Liselott Wickerts

doi:10.12688/f1000research.11519.1

Sune Forsberg, Frederic Bouvier + Show 2 more

Open Access

https://doi.org/10.12688/f1000research.11519.1

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Abstract

Obstructive sleep apnoea and obese hypoventilation is not uncommon in patients with obesity. Residuals effect from surgery/anaesthesia and opioid analgesics may worsen respiration during the first nights after bariatric surgery. The aim of this observational study was to monitor respiration on the first postoperative night following elective bariatric surgery. This observational study aimed to determine the incidence and severity of hypo/apnea.Oxygen desaturation was analysed by continuous respiratory monitoring. 45 patients were monitored with portable polygraphy equipment (Embletta, ResMed) during the first postoperative night at the general ward following elective laparoscopic bariatric surgery. Mean SpO2 was 93%; 10 patients had a mean SpO2 of less than 92% and 4 of less than 90%. The lowest mean SpO2 was 87%. There were 16 patients with a nadir SpO2 of less than 85%, lowest nadir SpO2 being 63%. An Apnoea Hypo/apnea Index (AHI) > 5 was found in 2 patients only (AHI 10 and 6), and an Oxygen Desaturation index (ODI) > 5 was found in 3 patients (24, 10 and 6, respectively). 3 patients had more prolonged (> 30 seconds) apnoea with nadir SpO2 81%, 83% and 86%. A low mean SpO2 and short episodes of desaturation were not uncommon during the first postoperative night following elective bariatric surgery in patients without history of night time breathing disturbance. AHI and/or ODI of more than 5 were only rarely seen. Night-time respiration monitoring provided sparse additional information. Thus, it seems reasonable to have low risk patients at general ward already in their first night after bariatric surgery.

Highlights

Obesity is on the increase in the western world and is associated with the development of several diseases
Each patient filled out a questionnaire to determine if there was a suspicion of obstructive sleep apnoea syndrome (OSAS) preoperatively; the questionnaire included the Epworth Sleepiness Scale (ESS)
Anaesthesia was induced with remifentanil target control infusion (TCI), set at a target of 6.0 ng/ml

Summary

Introduction

Obesity is on the increase in the western world and is associated with the development of several diseases It is a major risk factor for cardiovascular disease and diabetes, two of the leading causes of death globally. Residuals effect from surgery/anaesthesia and opioid analgesics may worsen respiration during the first nights after bariatric surgery. The aim of this observational study was to monitor respiration on the first postoperative night following elective bariatric surgery. Results: 45 patients were monitored with portable polygraphy equipment (Embletta, ResMed) during the first postoperative night at the general ward following elective laparoscopic bariatric surgery. Conclusions: A low mean SpO2 and short episodes of desaturation were not uncommon during the first postoperative night following elective bariatric surgery in patients without history of night time breathing disturbance. It seems reasonable to have low risk patients at general ward already in their first night after bariatric surgery

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