Patient transportation to post-anesthetic recovery area without supplemental oxygen: repercussions on oxygen saturation and risk factors associated with hypoxemia

Development of hypoxemia in the immediate postoperative period is a common event, even in healthy patients. In spite of what is known, it is a common practice to transport the patient to recovery room without adequate monitoring or administration of supplemental oxygen. To implement preventive measures to decrease the morbidity and mortality associated with this transportation, it is important to be aware of risk factors associated with the increased incidence of this complication. The aim of this work was to evaluate the incidence of changes in oxygen saturation and their relation to some associated risk factors during transportation of patients to recovery room without supplemental oxygen. The present study was performed on 970 patients undergoing elective surgeries. Four different anesthetic techniques were used; general anesthesia, general anesthesia with epidural analgesia, regional anesthesia with sedation and regional anesthesia without sedation. All patients were transported to the recovery area without supplemental oxygen and the peripheral oxygen was measured with a pulse oxymeter just before leaving the operating room. The incidence of mild hypoxemia was 27.7% while that of moderate/ severe hypoxemia was 12.1% of the studied patients. Significant reduction in peripheral oxygen was found in ASA II and III patients [p=0.001], in patients who received general anesthesia [p=0.001], in smokers [p=0.001], and in obese patients [p<0.001]. The incidence of mild hypoxemia was more among males, while incidence of moderate/ severe hypoxemia was more among females. No significant differences were found among different age groups or with different durations of surgery. It was concluded that it is necessary to monitor pulse oxymetry for all patients in the immediate postoperative period and patients with a high risk of developing postoperative hypoxemia must be transported with supplemental oxygen

Effect of albumin administration prior to graft reperfusion on the severity of reperfusion syndrome during living related liver transplantation

A prospective randomized study to evaluate the effect of intra-operative use of Albumin [20%] infusion prior to graft reperfusion on the severity of reperfusion syndrome during living donor liver transplantation Twenty patients were included with Child-Pughs C classification [ESLD]. Samples and measurements were taken pnor to reperfusion, during and after reperfusion of the donor liver graft. I. V fluids, blood and blood products were used to adjust a Hb level at [8-10 gm/dl] and Hct between 24-28% for better graft function and survival The reperfusion syndrome was severe as regard the decrease in MABP in No Albumin group [MABP = 48.2 +/- 7.23 mmHg] compared to Albumin group [MABP = 63.45 +/- 6.96 mmHg]. [P=00002] CVP was highly significant increased in Albumin group during reperfusion compared to No Albumin group [p = 0.0002]. Also. CVP correlated positively with S albumin level [r = 0.81. p = 0.002] dunng reperfusion syndrome. Patients of No Albumin group needed more motropic support than patients of Albumin group. In conclusion Albumin 20% in a dose of 1.5 ml/kg causes volume retention and expansion of intravascuiar volume which was a beneficial effect in liver transplant surgery to elevate the CVP prior to graft reperfusion and hence decreasing the severity of reperfusion syndrome and also elevating the already low serum albumin level and oncotic pressure

Stress among young Egyptian anesthesiologists

The practice of medicine offers many satisfactions, but there have been increasing sources of stress in the profession and increasing signs of stress- related problems among physicians. Aim of the work: was to explore the main causes of stress among young Egyptian anesthetists and to encourage them to incorporate stress management into their lives. This study was conducted on a sample of 120 anesthetists. They were chosen from both sexes with age range from 25-45 years. Anesthetists were divided into two main groups. Group A included 60 anesthetists working in Alexandria University Hospitals and group B included 60 anesthetists working in Ministry of Health Hospitals. Each main group was subdivided into three subgroups including 20 junior residents, 20 senior residents and 20 specialists. Each participant was allowed to answer a questionnaire booklet of 40 items. The most frequent source of stress among the whole studied sample was available resources and poor management [severely stressful for 76.6%]. This was significantly stressful for residents than specialists. Fallowed by stressful nature of anesthesia [severely stressful for 71.7%], and work overload and its effects on all aspects of life [severely stressful for 71.7%]. Work overload was significantly higher in group A than group B. Interpersonal relationships [severely stressful for 43.3%] was significantly higher in group A than group B and in senior residents than other subgroups. Finally, sources of dissatisfaction [moderately stressful for [99.2%]. Six anesthetists became smokers and 28 increased the rate of smoking after becoming anesthetists. Two anesthetists in the present study used to take psychoactive substances daily, one weekly and four monthly. The other 113 anesthetists never took but 13 of them thought in taking these substances. Two anesthetists claim that they thought in committing suicide weekly and another two monthly. Anesthesia is a stressful branch. Treatment of stress problems when they occur is not enough; prevention should be our aim. So, appropriate stress management skills should be included in the training program for all junior anesthetists