The influence of surgical sites on early postoperative hypoxemia in adults undergoing elective surgery

To determine the influence of the surgical sites on early postoperative hypoxemia, we studied postoperative hypoxemia in 994 patients, ASA physical status I or II, aged 18-68 yr, scheduled for various types of elective surgery. Patients were divided into three groups on the basis of the surgical sites: Group 1 = elective superficial plastic surgery (n = 288); Group 2 = upper abdominal surgery (n = 452); and Group 3 = thoracoabdominal surgery (n = 254). Anesthesia was maintained with 1%-2% enflurane and 67% nitrous oxide in oxygen; thiopental or fentanyl was given IV as required. SpO2 levels were recorded while patients breathed room air shortly after arrival in the recovery room (0 min) and 5, 10, 15, 20, 30, 40, 50, 60, 120, and 180 min thereafter. The results showed that during the early postoperative period, the degree of arterial desaturation and the incidences of hypoxemia (SpO2 86%-90%) and severe hypoxemia (SpO2 85%) were closely related to the operative sites and were greatest for thoracoabdominal operations, less for the upper abdominal operation, and least for the peripheral surgery. The incidence of hypoxemia and severe hypoxemia in the recovery room was 7% and 0.7%, respectively, in Group 1, 38% and 3% in Group 2, and 52% and 20% in Group 3. Mild airway obstruction and hypothermia in the postanesthesia recovery unit (PAR) were the predictive factors of early postoperative hypoxemia. We conclude that during the early postoperative period, there were significant differences in SpO2 levels and incidences of hypoxemia and severe hypoxemia among the three groups. We found that the severity of arterial desaturation and the incidence of hypoxemia during the early postoperative period are closely related to the surgical sites and are strongest for thoracoabdominal surgery, less for upper abdominal surgery, and least for peripheral surgery.