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Postoperative hypoxemia: common, undetected, and unsuspected after bariatric surgery.

Publication ,  Journal Article
Gallagher, SF; Haines, KL; Osterlund, LG; Mullen, M; Downs, JB
Published in: The Journal of surgical research
April 2010

Patients undergoing gastric bypass are at greater than ordinary risk for postoperative respiratory insufficiency, presumably related to obstructive sleep apnea (OSA) and patient-controlled analgesia (PCA). This study was proposed to quantify the magnitude of the problem.Fifteen patients undergoing gastric bypass had oxygen saturation (SpO(2)) recorded continuously, but not displayed, for 24h postoperatively; eight also had arterial blood analysis every 4h. All received narcotic PCA. SpO(2)<90% lasting more than 10 s was reviewed. Results are mean+/-SEM.Mean age was 44+/-4 y, and mean BMI was 48+/-2kg/m(2); 77% had OSA. Every patient had more than one episode with SpO(2)<90% for longer than 30s undetected by routine monitoring; most had multiple episodes. Nadir SpO(2) averaged 75% +/- 8%. Mean longest duration of desaturation below 90% averaged 21+/-15min. Mean PaCO(2) was 37+/-3mm Hg; maximum PaCO(2) was 47mm Hg.Severe and prolonged episodes of hypoxemia were a consistent finding, despite aggressive preoperative diagnosis and treatment of OSA, including use of CPAP postoperatively. Although some postoperative hypoventilation was expected, the degree and frequency of desaturation were surprising. No patient exhibited arterial PaCO(2) evidence of hypoventilation. No patient experienced cardiopulmonary arrest/instability, in spite of severe, repeated episodes of hypoxemia. In no instance was a significant hypoxemic episode suspected or detected. Continuous pulse oximetry monitoring, with an audible alarm set for a saturation less than 90% for 10 s, would have alerted providers to 100% of significant hypoxemic episodes. Our recommendation is routinely monitoring (with alarm capability enabled) every bariatric surgical patient, to prevent such occurrence.

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Published In

The Journal of surgical research

DOI

EISSN

1095-8673

ISSN

0022-4804

Publication Date

April 2010

Volume

159

Issue

2

Start / End Page

622 / 626

Related Subject Headings

  • Surgery
  • Prospective Studies
  • Postoperative Complications
  • Pilot Projects
  • Oxygen Consumption
  • Obesity, Morbid
  • Middle Aged
  • Male
  • Hypoxia
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
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Gallagher, S. F., Haines, K. L., Osterlund, L. G., Mullen, M., & Downs, J. B. (2010). Postoperative hypoxemia: common, undetected, and unsuspected after bariatric surgery. The Journal of Surgical Research, 159(2), 622–626. https://doi.org/10.1016/j.jss.2009.09.003
Gallagher, Scott F., Krista L. Haines, Lynette G. Osterlund, Matt Mullen, and John B. Downs. “Postoperative hypoxemia: common, undetected, and unsuspected after bariatric surgery.The Journal of Surgical Research 159, no. 2 (April 2010): 622–26. https://doi.org/10.1016/j.jss.2009.09.003.
Gallagher SF, Haines KL, Osterlund LG, Mullen M, Downs JB. Postoperative hypoxemia: common, undetected, and unsuspected after bariatric surgery. The Journal of surgical research. 2010 Apr;159(2):622–6.
Gallagher, Scott F., et al. “Postoperative hypoxemia: common, undetected, and unsuspected after bariatric surgery.The Journal of Surgical Research, vol. 159, no. 2, Apr. 2010, pp. 622–26. Epmc, doi:10.1016/j.jss.2009.09.003.
Gallagher SF, Haines KL, Osterlund LG, Mullen M, Downs JB. Postoperative hypoxemia: common, undetected, and unsuspected after bariatric surgery. The Journal of surgical research. 2010 Apr;159(2):622–626.
Journal cover image

Published In

The Journal of surgical research

DOI

EISSN

1095-8673

ISSN

0022-4804

Publication Date

April 2010

Volume

159

Issue

2

Start / End Page

622 / 626

Related Subject Headings

  • Surgery
  • Prospective Studies
  • Postoperative Complications
  • Pilot Projects
  • Oxygen Consumption
  • Obesity, Morbid
  • Middle Aged
  • Male
  • Hypoxia
  • Humans