Routine Oxygen Administration In The PACU: Should Everybody Have It?

摘要

Aim: To determine which group/s of patients should receive supplemental oxygen in the PACU.Methods: Sixty-six patients were involved in this observational study. Without altering PACU care, oxygen saturations were noted from arrival to discharge from PACU.Patients were assigned to two groups i.e. those that had supplemental oxygen and those who did not.Results: Incidence of hypoxaemia on arrival to PACU was 12 %, mean oxygen saturation in the hypoxaemic group was 92.25 ±1.39 % and mean oxygen saturation for all patients arriving in the PACU was 97.12 ± 2.46 %. More patients that had general anaesthesia and procedures of the head and neck received supplemental oxygen. Mean oxygen saturation values were similar between the two groups.Conclusion: Postoperative oxygen therapy should be reserved for patients with SpO2 of less than 94 % on arrival in the PACU. In this time of economic pressure on medicine, this will allow significant cost savings. Introduction One of the goals of the post anaesthesia care unit (PACU) is to prevent and treat respiratory complications following surgery and anaesthesia. Supplementary oxygen administered to patients in the PACU is a safe, simple and usually effective method to prophylactically ensure adequate oxygenation in most patients recovering from anaesthesia. Comroe1 in 1947 demonstrated that few physicians are capable of detecting mild degrees of arterial blood desaturation by the perception of “surface blueness”.The practice in most centres is to routinely give oxygen to postoperative patients irrespective of the type of surgery or technique of anaesthesia employed. In the absence of an adequate non-invasive monitoring device, this is a wise practice, however with the use of pulse oximetry, which allows the non-invasive monitoring of oxygen saturation to indicate the need for oxygen therapy this practice may be an unwarranted expenses.The purpose of this study was to determine which group/s of patients will benefit from supplemental oxygen in the PACU. Methods This prospective observational study was carried out at the post anaesthesia care unit (PACU) of the University College Hospital, Ibadan. In this study, routine PACU care was not altered and oxygen desaturation was taken as SpO2 reading ≤ 94%.Upon admission to the PACU some patients had 2 to 3 l/min of oxygen by facemask while others did not, this was based on the discretion of the PACU staff. During transportation to the PACU oxygen was not administered, but patients were put in the recovery position. While in the PACU, patients were monitored in our usual manner with measurements of blood pressure and pulse rate at least every ten minutes and when indicated by the type of surgery and the patient's physical conditions, continuous electrocardiography.Finger pulse oximeters (NONIN, Onyx, USA) were used for the SpO2 readings. All patients who had undergone elective operations under general and spinal anaesthesia were involved in the study. The patients had undergone head and neck, airway, anterior chest wall, abdominal and peripheral surgical procedures. Excluded were patients who had local anaesthesia for minor procedures and patients with pre-operative SpO2 value of ≤ 94%.Sixty-six patients were involved in the study. Observation and monitoring started immediately upon arrival in the PACU and continued until discharge. The oximeter was applied to the index finger of the hand opposite to the blood pressure cuff within a minute of arrival of patients in the PACU.The observer, a research assistant monitored oxygenation with the pulse oximeters continuously and recorded the SpO2 values throughout the period of stay in PACU. Patient's age, sex, ASA physical status, weight, nature of surgery, duration of anaesthesia and surgery and the anaesthetic technique used were all noted.All patients received preanaesthetic medication with diazepam orally night before and at 6am on the day of surgery. General anesthesia was provided with intravenous (Thio