Perioperative desaturation: incidence, causes, management and outcome.

OBJECTIVE: To determine the incidence, causes, management and outcome of desaturation occurring in the perioperative peroids (induction, maintence, emergence and recovery room) at Siriraj Hospital from June 2001-December 2001. METHOD: Perioperative incident reports were collected and analyzed. Patients were catergorized as having desaturation if the SPO2 was below 90 per cent for more than 3 minutes. The incidence, causes, management, and outcomes of these patients were examined in detail. RESULTS: 62 out of 16,716 cases (0.37%) experienced desaturation. Elective patients (0.41%) experienced desaturation more frequently than emergency patients (0.14%). The causes were airway obstruction, hypoventilation, endotracheal tube problems, aspiration, atelectasis, and pulmonary edema. These patients were treated with higher FiO2, airway management, and ventilatory support which led to unplanned ICU admission. 4 patients developed cardiac arrest with successful resuscitation although 2 patients had cerebral infarction. CONCLUSION: Perioperative desaturation is an important sign of respiratory complications that should be recognized and treated immediately to prevent mortality and serious morbidity.

Preoperative autologous blood collection and haemodilution with dextran.

Thirty patients, ASA class I-II with haemoglobin level > 12.5 gm percent, who underwent elective gynaecological surgery were included in the study. Control blood samples for haematocrit, haemoglobin, electrolytes, serum osmolarity, coagulogram and platelet function were investigated before the autologous blood was collected and haemodiluted with 3 percent dextran-40 solution. The cardiovascular responses, arterial blood gases, urine output and central venous pressure were also recorded. After the end of haemodilution, another blood samples (as study samples) were once collected for analysis. Haematocrit, haemoglobin, sodium and potassium showed to decrease significantly. However, the serum osmolarrity, coagulogram and platelet function had no any significant differences. All parameters were within normal limits. In conclusion, the autologous blood collection and haemodilution technique was suitable and possibly practical in ever elective surgical patients without any undesirable side effects.