Incidence Of Intraoperative Hypoxemia Research Articles

Lung isolation—a personalized and clinically adapted approach to control bronchoscopy-associated acute massive airway hemorrhage

BackgroundThe current concept of bronchoscopy-associated massive airway hemorrhage is not accurate enough, and the amount of bleeding as the only evaluation criterion cannot comprehensively evaluate magnitude of the effects and the severity.ObjectiveTo propose the concept of bronchoscopy-associated acute massive airway hemorrhage, analyze its impact on patients and highlight the treatment approach of acute massive airway hemorrhage without ECMO support.DesignsA retrospective cohort study.SettingInclude all patients who received bronchoscopy intervention therapy at Interventional Pulmonology Center of Emergency General Hospital from 2004 to December 2021.Patients223 patients met the inclusion criteria.InterventionPatients were divided into two groups: acute massive airway hemorrhage group (n = 29) and non-acute massive airway hemorrhage group (n = 194).Main outcome measuresPerioperative adverse events between two groups were the main outcome. Secondary outcome was the impact of lung isolation on patient in group Acute.ResultsThe incidence of acute massive airway hemorrhage was 0.11%, and the incidence of non-acute massive airway hemorrhage was 0.76% in this study. There were significant differences in the incidence of intraoperative hypoxemia, lowest SpO2, hemorrhagic shock, cardiopulmonary resuscitation, intraoperative mortality, and transfer to ICU between acute group and non-acute group (P<0.05, respectively). Lung isolation was used in 12 patients with acute massive airway hemorrhage, and only 2 patients died during the operation.ConclusionBronchoscopy-associated acute massive airway hemorrhage had more serious impact on patients due to rapid bleeding, blurred vision of bronchoscopy, inability to stop bleeding quickly, blood filling alveoli, and serious impact on oxygenation of the lung lobes. Polyvinyl chloride single-lumen endotracheal intubation for lung isolation, with its characteristics of low difficulty, wide applicability and available in most hospitals, may reduce the intraoperative mortality of patients with bronchoscopy-associated acute massive airway hemorrhage.Trial registrationChinese Clinical Trial Registry on 13/03/2022. Registration number: ChiCTR2200057470.

Effect of high flow nasal catheter oxygen to prevent hypoxemia in endoscopic retrograde cholangiopancreatography surgery in aged

Objective: To explore the effect of high-flow nasal catheter oxygen inhalation in preventing hypoxemia during endoscopic retrograde cholangiopancreatography (ERCP) surgery in elderly patients. Methods: From September 2021 to September 2022, 116 elderly patients (aged ≥ 70 years) who underwent elective ERCP in the Northern Theater General Hospital were prospectively selected, then divided into general nasal catheter oxygen inhalation group [group C, 31 males and 27 females, aged (79.8±6.4) years] and high-flow nasal catheter oxygen inhalation group [group H, 33 males and 25 females, aged (81.4±6.7) years], with 58 patients in each group. All patients were monitored for anesthesia by target-controlled infusion of propofol and remifentanil. The main outcome index was the incidence of intraoperative subclinical hypoxemia (90% ≤ SpO2 < 95%, duration >5 s), hypoxemia (75% < SpO2 < 90%, 5 s < duration ≤ 60 s) and severe hypoxemia (SpO2 < 75% or SpO2 < 90%, duration > 60 s). Secondary observation measures were SpO2 from T0 to T5 (T0, before anesthesia induction; T1, immediately after anesthesia induction; T2, endoscopic introduction; T3, duodenal papula intubation; T4, endoscopic withdrawal; T5, postoperative awakening), the arterial oxygen partial pressure (PaO2), carbon dioxide partial pressure (PaCO2) and pH at T0, 15 min after the induction and T5. Results: The incidence of intraoperative subclinical hypoxemia in group C and group H was 12.0% (7/58) and 3.4% (2/58) respectively, which showed no significant statistical difference (P=0.165) from each other. The incidence of intraoperative hypoxemia in group H was 8.6% (5/58), which was significantly lower than 31.0% (18/58) of group C (P=0.003). Neither group had intraoperative severe hypoxemia. SpO2 of group H were (98.2±0.9)%, (98.2±0.9)%, (97.8±1.7)% and (97.7±1.7)% at T1, T2, T3, T4, which were higher than (96.8±2.1)%, (96.4±3.0)%, (96.1±2.9)% and (96.4±3.4)% in group C (all P<0.05). PaO2 at 15 min after induction in group H was (240.5±46.7) mmHg (1 mmHg=0.133 kPa), which was higher than that of group C (170.6±33.4) mmHg (P<0.001). There was no statistically significant difference in pH and PaCO2 between the two groups of patients at each timepoint. Conclusion: High flow nasal catheter oxygen can effectively reduce the incidence of hypoxemia in ERCP in elderly patients.

Comparison of the Effects of Esketamine/Propofol and Sufentanil/Propofol on the Incidence of Intraoperative Hypoxemia during Bronchoscopy: Protocol for a Randomized, Prospective, Parallel-Group Trial.

Background: Propofol, ketamine, and sufentanil are the most commonly used anesthetics during bronchoscopy, alone or in combination, for sedation. Esketamine is an s-enantiomer of ketamine racemate and has both sedative and analgesic effects. Esketamine does not inhibit respiration and maintains hemodynamic stability. This study aims to compare the clinical efficacy of esketamine/propofol with sufentanil/propofol for patients during bronchoscopy. Methods: Patients undergoing bronchoscopy will be randomly assigned to receive either sufentanil/propofol (sufentanil group; n = 33; sufentanil: 0.2 μg/kg) or esketamine/propofol (esketamine group; n = 33; esketamine: 0.2 mg/kg) for sedation and analgesia. Intraoperative clinical information, general anesthetic drug dosage, the incidence of intraoperative hypoxemia, total time of hypoxemia, awakening time, delirium, nausea and vomiting, adverse reactions, and patient satisfaction will be collected. Discussion: Hypoxia has detrimental effects on patients with respiratory disease. Ameliorating hypoxemia in patients undergoing bronchoscopy is critical. Our results will provide effective sedation with esketamine in patients undergoing bronchoscopy. Trial registration: Chinese clinical trial registry: ChiCTR2200058990.

Anesthetic effect of different doses of butorphanol in patients undergoing gastroscopy and colonoscopy

BackgroundThis study aimed to investigate the anesthetic effect of butorphanol with different doses in patients undergoing gastroscopy and colonoscopy.Methods480 patients undergoing gastroscopy and colonoscopy were recruited and randomly divided into four groups to receive different doses of butorphanol (Group A = 2.5 μg/kg, Group B = 5 μg/kg, Group C = 7.5 μg/kg and Group D = 10 μg/kg). Butorphanol was administered 5 min before propofol infusion. The primary outcome was the incidence of body movement. Secondary outcomes were postoperative recovery time, length of stay in the Post-Anesthesia Care Unit (PACU), the total dose of propofol, and the incidence of intraoperative hypoxemia, propofol injection pain, cough, postoperative nausea and vomiting, drowsiness, and dizziness.ResultsThe incidence of body movement and the dose of propofol in Group C and D were lower than those in Group A and B (P < 0.05). The incidence and intensity of propofol injection pain and the incidence of cough in Group B, C, and D were lower than those in Group A (P < 0.05). The length of stay in PACU and the incidence of postoperative drowsiness and dizziness were higher in Group D than in Group A, B, and C (P < 0.05).ConclusionIntravenous pre-injection of 7.5 μg/kg butorphanol with propofol can be the optimal dosage for patients undergoing gastroscopy and colonoscopy.Trial registration: Trial registration: Chinese Clinical Trial Registry, ChiCTR2000031506. Registered 3 April 2020—Retrospectively registered, http://www.medresman.org.cn.

Incidence and Risk Factors of Hypoxemia During Interventional Rigid Bronchoscopy Under Spontaneous-assisted Ventilation.

Interventional rigid bronchoscopy for tracheobronchial stenosis can be performed under total intravenous anesthesia and spontaneous-assisted ventilation. Intraoperative hypoxemia can occur during this procedure, but the incidence and risk factors have not yet been determined. Medical records of patients who underwent rigid bronchoscopy for the treatment of tracheobronchial stenosis under total intravenous anesthesia and spontaneous-assisted ventilation during the study period from January 2011 to December 2012 were retrospectively reviewed. There were 126 patients who underwent 263 procedures. The 2 main causes of tracheobronchial stenosis were tuberculosis (41.3%) and malignancy (35.7%). The 2 main locations of stenotic area were the trachea (58.6%) and the left main bronchus (46.4%). Tracheobronchial dilatation and stent insertion were performed in 78.7% and 21.3% of patients, respectively. The incidence of intraoperative hypoxemia was 25.5%. Independent risk factors for intraoperative hypoxemia were a degree of tracheal stenosis ≥75% (odds ratio: 2.48; 95% confidence interval, 1.19-5.17) and tumor removal procedure (odds ratio: 2.9; 95% confidence interval, 1.13-7.41). Incidence of intraoperative hypoxemia during interventional rigid bronchoscopy for tracheobronchial stenosis under spontaneous-assisted ventilation was 25.5%. Risk factors for hypoxemia were a degree of tracheal stenosis ≥75% and tumor removal procedure.

Increasing body mass index and the incidence of intraoperative hypoxemia

Study objectiveObese patients regularly present for surgery and have greater hypoxemia risk. This study aimed to identify the risk and incidence of intraoperative hypoxemia with increasing body mass index (BMI). DesignThis was a retrospective cohort study. SettingOperating room. PatientsA total of 15,238 adult patients who underwent general anesthesia for elective noncardiac surgery at a single large urban academic institution between January 2013 and December 2014. InterventionsUnadjusted and risk-adjusted logistic regression analyses explored the relationship between increasing categories of BMI and intraoperative hypoxemia, severe hypoxemia, and prolonged hypoxemia. MeasurementsIntraoperative pulse oximeter readings and preoperative patient characteristics. Main resultsWith normal BMI, 731 (16%) patients experienced hypoxemia compared with 1150 (28%) obese patients. Adjusted odds ratio (AOR) of intraoperative hypoxemia increased with each category of BMI from 1.27 (95% confidence interval [CI], 1.12-1.44) in overweight patients to 2.63 (95% CI, 2.15-3.23) in patients with class III obesity. AOR of severe hypoxemia was significant with class I obesity (AOR, 1.32; 95% CI, 1.08-1.60), class II obesity (AOR, 2.01; 95% CI, 1.59-2.81), and class III obesity (AOR, 2.27; 95% CI, 1.75-2.93). AOR of prolonged hypoxemia increased with BMI from 3.29 (95% CI, 1.79-6.23) with class I obesity to 9.20 (95% CI, 4.74-18) with class III obesity. ConclusionsDespite existing practices to limit hypoxemia in obese patients, the odds of experiencing intraoperative hypoxemia increase significantly with increasing categories of BMI. Further practices may need to be developed to minimize the risk of intraoperative hypoxemia in obese patients.

Incidence of Intraoperative Hypoxemia in Children in Relation to Age

Incidence of Intraoperative Hypoxemia in Children in Relation to Age

Incidence of Intraoperative Hypoxemia in Children in Relation to Age

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. 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. 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). 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.