ABSTRACT
BACKGROUND: The present study was part of the Thai Anesthesia Incidents Study (THAI Study) of anesthetic adverse outcomes. OBJECTIVE: To determine factors related to intraoperative oxygen desaturation (SpO2 < or =85% or < 90% for more than 3 min). MATERIAL AND METHOD: During a 12-month period (February 1, 2003 - January 31, 2004), a prospective multicentered registry of patients receiving anesthesia was conducted in 20 hospitals across Thailand Anesthesia personnel filled up patient-related, surgical-related, and anesthesia related variables and adverse outcomes including intraoperative oxygen desaturation. A case-control (1:4) study of patients with and without intraoperative oxygen desaturation in the THAI Study database was done. Univariate and multivariate analysis were used to identify factors related to intraoperative oxygen desaturation. A p-value < 0.05 was considered as significant. RESULTS: Among 152,314 patients without preanesthetic desaturation in the database, 328 cases of intraoperative oxygen desaturation were matched with 1312 control patients without desaturation. Variables that predict desaturation by multiple logistic regression were age less than 5 years old [OR 9.3 (95% CI 5.4-16.0)], ASA physical status 3, 4, 5 [OR 3.1 (95% CI 2.2-4.3)], history of upper respiratory tract infection [OR 10 (95% CI 1.9-51.6)], history of asthma [OR 2.9 (95% CI 1.0-9.5)], general anesthesia [OR 4.0 (95% CI 2.4-6.7)] duration of anesthesia 31-90 min [OR 1.9 (95% CI 1.2-3.0)], duration of anesthesia 91-150 min (OR 2.2 (95% CI 1.3-3.6)], and duration of anesthesia >150 min [OR 2.0 (95% CI 1.2-3.4)]. CONCLUSION: Knowing the risk factors of intraoperative oxygen desaturation helps improving personnel to improve preanesthetic conditions and facilitate early detection as well as prompt treatment of intraoperative oxygen desaturation.
Subject(s)
Adolescent , Adult , Age Factors , Aged , Anesthesia/adverse effects , Anesthesiology , Anesthetics/adverse effects , Hypoxia/etiology , Case-Control Studies , Child , Child, Preschool , Databases as Topic , Female , Health Status Indicators , Humans , Intraoperative Complications , Male , Middle Aged , Oxygen Consumption , Oxygen Inhalation Therapy , Perioperative Care , Prospective Studies , Registries , Risk Factors , ThailandABSTRACT
BACKGROUND: To prevent awareness and uterine atony among parturients during general anesthesia for caesarean section, volatile anesthetic agents have been limited to 0.5 MAC in 50% N2O. This technique appeared to be inadequate to produce BIS values less than 60 in isoflurane and sevoflurane. OBJECTIVE: To assess BIS value during general anesthesia with 3% and 4.5% desflurane in 50% N2O before delivery. MATERIAL AND METHOD: The parturients were blinded and randomized in opaque envelopes to one of the two study groups. Seventy-two elective caesarean section ASA I - II parturients were induced and intubated with thiopental 4 mg/kg, succinylcholine 1.5 mg/kg and were received either 3% or 4.5% desflurane in 50% N2O to maintain general anesthesia. Both groups received rocuronium 0.6 mg/kg for muscle relaxation. Morphine 0.1 mg/kg and midazolam 0.06 mg/kg were administered after delivery. RESULTS: There were no differences in demographic data in both groups. The incidences of patients with a satisfactory BIS score (< 60) in the 4.5% desflurane group was 81% that was significantly more than 42% in the 3% desflurane group (p < 0.000). Mean BIS values at neonatal delivery were 62 +/- 8 in the 3% desflurane group, versus 49 +/- 12 in the 4.5% desflurane group. Indices of maternal and neonatal outcome were similar between the two groups. CONCLUSION: General anesthesia for caesarean section with 4.5% desflurane in 50% N2O maintained BIS < 60 more significantly than 3% of desflurane in 50% N2O without maternal and neonatal adverse effects in healthy paturients.
Subject(s)
Adult , Anesthesia, Obstetrical , Anesthetics, Inhalation , Cesarean Section , Double-Blind Method , Electroencephalography , Female , Humans , Isoflurane/analogs & derivatives , Monitoring, Intraoperative , Nitrous Oxide , PregnancyABSTRACT
The aim of this study was to determine the effect of ephedrine on the onset time of rocuronium. The study population was 60 ASA physical status 1 and 2 patients, aged 15-60 years scheduled for elective surgery under general anesthesia at Ramathibodi Hospital. The patients were randomly assigned into 2 groups. Group I (ephedrine group), ephedrine 70 microg/kg was given 1 minute before induction and group II (control group), saline was given instead of ephedrine and midazolam 7.5 mg was given orally 30-60 minutes before the induction. Anesthesia was induced with fentanyl 1 microg/kg and sodium thiopentone 3-5 mg/kg. The patient was intubated with 0.9 mg/kg of rocuronium. The intubation time (from rocuronium administration to the time of intubation) was predetermined by the Dixon's up and down method (with 5 seconds as a step size) for each patient and started at 60 seconds for the first patient in each group. The intubation time in the ephedrine group (39.41 +/- 4.64 seconds) was significantly different from the control group (59.17 +/- 9.00 seconds); p-value < 0.01. The hemodynamics were similar in both groups. Conclusion: Intravenous ephedrine shortened the onset time of rocuronium with no significant adverse hemodynamic effects. As an alternative to suxamethonium for rapid intubation, the authors recommend the use of ephedrine 70 microg/kg at one minute before induction followed by 0.9 mg/kg of rocuronium intravenously in healthy patients. The intubation could be achieved at 40 seconds after the administration.