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A1820
October 16, 2007 2:00 PM - 4:00 PM Room Hall D, Area P, |
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| Apnea/Hypopnea Following General Anesthesia for Major Surgery | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Richard E. Moon, M.D., Andrew D. Krystal, M.D., Lynn E. Eschenbacher, Pharm.D., John C. Keifer, M.D., Brian Ginsberg, M.B., B.Ch. Anesthesiology, Duke University Medical Center, Durham, North Carolina |
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Introduction: Disturbed breathing and arterial Hb-O2 desaturation are known to occur after surgery, however there have been few published studies. Cronin (Sleep 2001;24:39) evaluated sleep stages after surgery but did not comment on apnea/hypopnea. Loick (Eur J Anaesthesiol 1997;14:258) recorded apneic events in 20 patients after ophthalmic surgery during the first 12 hours after transfer from the PACU to the ward and observed no difference from a control period before surgery (approximately 2 apneas/h). We hypothesized that compared with ophthalmic surgery, apnea/hypopnea would occur more frequently in patients after major surgery. Methods: Polysomnography (EEG, thoracic/abdominal movement, airflow, SpO2, orofacial EMG, eye movement) and capnography was obtained from 8 unselected patients immediately after major surgery under general anesthesia requiring postoperative inpatient care. Signals were collected by a wireless preamplifier unit and recorded on a bedside portable computer. Patients were monitored until they were able to get out of bed. Each record was scored by a sleep specialist and apnea/hypopnea events were recorded. Results: Patient characteristics are shown in the Table. None of the patients had previously been diagnosed with sleep apnea. There were no significant cardiopulmonary co-morbidities except in one patient (Pt H in Table) who had severe COPD and chronic hypercapnia. Six patients had abdominal procedures; two had spinal procedures. Patients were monitored for a mean of 16.1 h (range 3.4-41). One patient requested removal of the recording apparatus after 3½ h. All patients received intravenous and/or oral opiates for analgesia. Seven of 8 patients received oxygen via nasal cannulae during the first postoperative night (Pt A did not). The number of apneic events exceeded 5 per hour in 5 of 8 patients. Most events occurred within 12 hours after surgery. However in one patient with COPD there was a second peak starting 20 hours after surgery. There was no hypoxemia except in patient B, in whom there were brief periods in which SpO2 decreased below 90% throughout the monitoring period. Conclusions: We conclude that apnea/hypopnea commonly occurs after major surgery under general anesthesia. In this small series the frequency of apnea/hypopnea appears to be related to patient age. Hypoxemia was avoided in 7 of 8 patients.[table1][figure1] Anesthesiology 2007; 107: A1820 |
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Figure 1
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