JOURNAL CLUB PRESENTATION

MODERATOR:
Asst.Prof. Sujeeta Bajracharya
Department of MDGP and EM
NAIHS

PRESENTER:
Dr Gaurav Paudel
3rdyear resident
Department of MDGP and EM
NAIHS
 DETAILS
AUTHORS A. Maity, D. Saha, S swaika, S. G .Maulik,
B.Choudhury, M. Sutradhar
JOURNAL Anesthesia : Essays and Researches
VOLUME/ISSUE 6/1
PAGES 34-37
TYPE OF Prospective, Observational, randomised
STUDY
DATE OF 2018 january – 2019 december
STUDY
DATE OF January 2020
PUBLICATION
Department of Orthopaedics, 1Anaesthesia, Burdwan Medical College,
Burdwan,
2Anesthesiology, Bankura Sammilani Madical College, Bankura,
West Bengal, India
RATIONALE FOR CHOOSING THE TOPIC

• Most of our patients are transported to the Post operative

units without oxygen supplementation.

• In the Post operative unit itself, continuous monitoring with

pulse oximeter are not possible for every patient.

A topic to state the need for monitoring oxygen saturation ,

providing supplemental oxygen and identifying the risk
group.
 Introduction:

• Hypoxemia is defined as decreased oxygen

levels in the blood (e.g, decreased PVo2 or decreased
Pao2.),

• According to study by Tyler et al – SaO2 decreases

significantly in large number of patients who were
transfered without supplemental oxygen to the recovery
room.
• Postoperative hypoxemia is common and has been
documented even after minor procedures under GA

• Arterial hypoxemia occur as a result of

Low PaO2 increased pO2 [A-a]difference

As a consequence of anesthesia :

• decreased FRC,
• increased CC ,
• a V/Q mismatch ,
• or development of atelectasis,
• CO2 retention due to hypoventilation
• Hypoxemia is one of the most feared critical events during
anesthesia and recovery period too.

• Occuring anytime periopeartively, if not corrected early

,severe hypoxemia can lead devastating neurological
handicaps, postoperative complication or even death.

• Early detection of hypoxemia leads to early correction of

the hypoxemic event
Objective of the study

• To determine the incidence and degree of hypoxia

during transfer of patients from operation theater to
recovery room and in the recovery room.

• To identify predictive factors if any

 Study methodology

• Permission obtained from hospital ethical committee

• A prospective,randomised, observational study
• Informed consent taken from enrolled patients

• Inclusion
• Adult 18years-60years

• ASA I and II
• Elective non cardiothoracic surgery under GA.
 Sample size - 150

RANDOMISED

GROUP I GROUP II
75 patients 75 patients
Received oxygen at 2l/min via No supplemental oxygen
nasopharyngeal catheter during
transfer from OT room to recovery
room and continued in Recovery
room upto 4hours
Definitions:

• Hypoxemia-
Fall in oxygen saturation of arterial blood below 90%

Mild hypoxemia 86-90%

Moderate hypoxemia 81-85%
Severe hypoxemia 76-80%
Extreme hypoxemia <76%
• Level of conciousness

Level of conciousness grade

Unresponsive 0
Arousable 1
Awake 2
• Anesthetic procedure was same for both the groups

• Premedication with
Pentazocin 30mg
Phenergan 30mg IM
Glycopyrolate 0.2mg

• Standard maintainance of anesthesia

• Reversal with neostigmine + glycopyrolate/atropine.

Drugs causing respiratory depression – avoided during
anesthesia

After extubation- 100 % oxygen delivered at 6-8l/min via

open circuit for atleast 5 minutes

Transfered to recovery room with SaO2 monitoring with

pulse oximeter
Data recorded every minute during transfer

In recovery room : monitoring of BP,pulse,temperature, RR,

colour at 30minutes interval
Statistical analysis

• Data analyses tools:

• Students ‘t’ test : for quantitative data

• Chi square test or fishers exact test : for categorical

variables

P value of <0.05 were considered to indicate statistical

significance.
 Result
Groups comparable in terms of

1. Body weight
2. Duration of surgery
3. Hemoglobin level

Sex distribution
Group I Group II
Male 54.66% 50.66%
Female 45.34% 49.34%
• Vital signs in postoperative recovery room - comparable
pulse rate
respiratory rate
blood pressure
temperature
colour

• Level of conciousness
• Incidence of hypoxemia in different level of conciousness
Discussion:

As per the study,

• None of the patients in group I showed hypoxemia
During transport In recovery room
Group I GroupII Group I Group II

• Among the three subgroups of age :

Higher age group – 46-60years – had maximum incidence of
hypoxemia[43.47%]
Least in younger age [17.24%] [P= 0.03]
• Higher incidence were seen in arousable group [45.45%]
Compared to awake patients [14.28%] [P= 0.028]

• There were no statistically significant difference in regards

to duration of surgery.
 Conclusion:

 Oxygen supplementation should be given to all the

patients who have undergone general anesthesia , both
during transfer from operation theater to the recovery
room and for at least 2 hours in the recovery room.
Limitations of the study:
Not mentioned

Conflicts of interest
none
Literature review:
1,
2.
3.
4.
Critical analysis

• Title of the study:

The title seems to be specific and focused.

• Abstract:
Abstract seems to be a clear representation of the article
and is in correct form
• Keywords : were used appropriately

• Introduction: the purpose of the study is clear in its

introduction

• Hypothesis : has not been mentioned

• Objectives:
Mentioned clearly
Method :
• Approval taken
• Design of study prospective
• Blinding: not done
• Study place
• Department of Orthopaedics, 1Anaesthesia, Burdwan
Medical College, Burdwan,
• 2Anesthesiology, Bankura Sammilani Madical College,
Bankura,West Bengal, India
• Study design : randomised, prospective, observational
• Study duration Jan 2009- dec 2010
• Sample size : 150 , calculation method not mentioned
• Randomisation : done , but over a heterogenous group
of surgical patients.
• Inclusion criteria: 18-60 years ASA PS I and II , no
specification of type of surgery

• Exclusion criteria : not mentioned

• Statistical analysis :appropriate tests used. Mentioned

in brief

• Results: mentioned and presented in tabulated form

• Discussion : compared with previous studies, no recent

studies for comparison
• Limitations : not mentioned

• Recommendations: not mentioned

• Conclusion: concluded as per the objective of the study

• Reproducibility : can be reproduced at our setting

 Message:
• Arterial hypoxemia in postoperative period is seen to be
common ;irrespective of duration /type of surgery and
anesthesia and ASA status.
more commonly in age >46years.

• To monitor all the patients for SaO2 by pulse oximeter during

transfer to pick up any case of hypoxaemia at the earliest
opportunity.
• Every patient in the postoperative unit are not continously
monitored for spo2 in our setting.
Hence
• Oxygen supplementation with oxygen via nasal cannula
should be continued during the transfer and in
postoperative unit at 2l/min for atleast 2hours of immediate
postoperative period.
THANK - YOU