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Impact of medical training and clinical experience on the assessment of oxygenation and hypoxaemia after general anaesthesia: an observational study

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Abstract

In Germany it is common practice to use pulse oximetry and supplementary oxygen only on request in patients breathing spontaneously transferred to the post-anaesthesia care unit (PACU) following surgery under general anaesthesia. The main aim was to study the influence of medical training and clinical experience on assessing SpO2 and detecting hypoxaemia in these patients. The second aim was to do a preliminary assessment whether this practice can be found in countries other than Germany. Anaesthetists, nurses and medical students estimated SpO2 in patients breathing room air at the end of transfer to the PACU following surgery (including all major surgical fields) under general anaesthesia. Estimated SpO2 was compared to SpO2 measured by pulse oximetry. A survey was carried out among European anaesthesists concerning the use of pulse oximetry and supplementary oxygen during patient transfer to the PACU. Hypoxaemia (SpO2 < 90 %) occurred in 154 (13.5 %) out of 1,138 patients. Anaesthetists, nurses, and medical students identified only 25, 23, and 21 patients of those as being hypoxaemic, respectively. Clinical experience did not improve detection of hypoxaemia both in anaesthetists (p = 0.63) and nurses (p = 0.18). Use of pulse oximetry and supplemental oxygen during patient transfer to the PACU in European countries differs to a large extent. It seems to be applied only on request in many hospitals. Considering the uncertainty about deleterious effects of transient, short lasting hypoxaemia routine use of pulse oximetry is advocated for patient transfer to the PACU.

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Abbreviations

AAGBI:

Association of Anaesthetists of Great Britain and Ireland

ASA:

ASA physical status classification system (based on ASA = American Society of Anesthesiologists)

AZ:

“Aktenzeichen” (file-number)

BMI:

Body mass index

CI:

Confidence interval

ESA:

European Society of Anaesthesiology

FiO2 :

Inspired oxygen fraction

FeO2 :

Expired oxygen fraction

ICU:

Intermediate care unit

MH:

Major hospital

N2O:

Nitrous oxide

OR:

Operating room

PACU:

Post-anaesthesia care unit

P all:

Pulse oximetry is used in all patients

P on request:

Pulse oximetry is used on request only

SD:

Standard deviation

SpO2 :

Saturation of hemoglobin with oxygen as measured by pulse oximetry

TIVA:

Total intravenous anaesthesia

UH:

University hospital

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Acknowledgments

The authors thank all the colleagues in Denmark, the Netherlands, and at the 2013 Euroanaesthesia meeting who took part in the study and thereby helped to obtain important data for this study. The authors also thank all staff from Marburg university hospital, department of anaesthesia who helped to acquire data for the observational part of this study.

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical standard

The study complies with the current laws of the country in which it was performed.

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Authors and Affiliations

  1. Department of Anaesthesia and Intensive Care, University Hospital Giessen-Marburg, Marburg Campus, Baldingerstrasse, 35033, Marburg, Germany

    Hansjörg Aust, Leopold H. J. Eberhart, Melanie Brieskorn, Julian Heine, Christian Arndt & Dirk Rüsch

  2. Department of Anaesthesia and Critical Care, University Hospitals of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany

    Peter Kranke

  3. Department of Anaesthesia, Juliane Marie Centre, University of Copenhagen, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark

    Arash Afshari

  4. Department of Anaesthesia, Erasmus University Medical Center - Sophia Children’s Hospital, Wytemaweg 80, 3015 CN, Rotterdam, Netherlands

    Frank Weber

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  1. Hansjörg Aust
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  2. Peter Kranke
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  3. Leopold H. J. Eberhart
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  6. Melanie Brieskorn
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  7. Julian Heine
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  8. Christian Arndt
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  9. Dirk Rüsch
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Correspondence to Hansjörg Aust.

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Aust, H., Kranke, P., Eberhart, L.H.J. et al. Impact of medical training and clinical experience on the assessment of oxygenation and hypoxaemia after general anaesthesia: an observational study. J Clin Monit Comput 29, 415–426 (2015). https://doi.org/10.1007/s10877-014-9620-4

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  • DOI: https://doi.org/10.1007/s10877-014-9620-4

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