Obese patients: respiratory complications in the post-anesthesia care unit.

INTRODUCTION: Obesity has been associated with respiratory complications, and the majority of these complications occur in the Post-Anesthesia Care Unit (PACU). The aim of this study was to evaluate the outcome and incidence of adverse respiratory events (AREs) in obese patients during their stay in the PACU METHODS: We conducted a prospective control study that included 27 obese patients matched with an equal number of patients with body mass index (BMI)<30 (non-obese control group); the 2 groups of patients were similar in respect to gender distribution, age, and type of surgery and had been admitted into the PACU after elective surgery (May 2011). The AREs were identified during PACU stay. Descriptive analysis of variables was performed, and the Mann-Whitney U test, Chi-square test, or Fisher's exact test were used for comparisons. Associations with AREs were studied using univariate and multivariate logistic regression models. RESULTS: There was a higher frequency of STOP-BANG ≥3 (89% vs. 11%, P<.001) among obese patients and they were less frequently scheduled to undergo high-risk surgery (7% vs. 41%, P=.005) and major surgery (4% vs. 15%, P=.008). Obese patients had more frequent AREs in the PACU (33% vs. 7%, P<.018). Multivariate analysis identified obesity and residual neuromuscular blockade as independent risk factors for the occurrence of AREs. Stay in the PACU was longer for obese patients (120min vs. 84min, P<.01). CONCLUSIONS: Obesity was considered an independent risk factor for AREs in the PACU. Obese patients stayed longer in the PACU, but they did not stay longer in the hospital.

Patients with a high risk for obstructive sleep apnea syndrome: postoperative respiratory complications.

BACKGROUND: STOP-BANG score (snore; tired; observed apnea; arterial pressure; body mass index; age; neck circumference and gender) can predict the risk of a patient having Obstructive Syndrome Apnea (OSA). The aim of this study was to evaluate the incidence STOP-BANG score≥3, in surgical patients admitted to the Post-Anesthesia Care Unit (PACU). METHODS: Observational, prospective study conducted in a post-anesthesia care unit (PACU) during three weeks (2011). The study population consisted of adult patients after noncardiac and non-neurological surgery. Patients were classified as high risk of OSA (HR-OSA) if STOP-BANG score≥3 and Low-risk of OSA (LR-OSA) if STOP-BANG score<3 (LR-OSA). Patient demographics, intraoperative and postoperative data were collected. Patient characteristics were compared using Mann-Whitney U-test, t-test for independent groups, and chi-square or Fisher's exact test. RESULTS: A total of 357 patients were admitted to PACU; 340 met the inclusion criteria. 179 (52%) were considered HR-OSA. These patients were older, more likely to be masculine, had higher BMI, higher ASA physical status, higher incidence of ischemic heart disease, heart failure, hypertension, dyslipidemia and underwent more frequently insulin treatment for diabetes. These patients had more frequently mild/moderated hypoxia in the PACU (9% vs. 3%, p=0.012) and had a higher incidence of residual neuromuscular blockade (NMB) (20% vs. 16%, p=0.035). Patients with HR-OSA had a longer hospital stay. CONCLUSIONS: Patients with HR-OSA had an important incidence among patients scheduled for surgery in our hospital. These patients had more co-morbidities and were more prone to post-operative complications.

El bloqueo neuromuscular residual como factor de riesgo para eventos críticos respiratorios en la Unidad de Recuperación Postanestésica / Residual neuromuscular block as a risk factor for critical respiratory events in the post anesthesia care unit

Objetivo. El bloqueo neuromuscular residual es una importante complicación postoperatoria asociada al uso de fármacos bloqueantes neuromusculares. El objetivo de este estudio fue valorar la incidencia de bloqueo neuromuscular residual en una unidad de recuperación postanestésica (URPA) y evaluar su asociación con eventos respiratorios críticos. Material y métodos. Estudio de cohortes, prospectivo realizado en una URPA durante un período de 3 semanas. Se incluyó a doscientos dos pacientes adultos sometidos a cirugía programada no cardiaca no-intracraneal. La variable de resultado principal fue la presencia de bloqueo neuromuscular residual después del ingreso en unidad de recuperación postanestésica definido como un cociente del tren de cuatro estímulos-TOFr<0,9 y objetivamente cuantificado usando aceleromiografía. Se registraron datos demográficos, variables perioperatorias, tiempo de permanencia en la unidad, tiempo de estancia hospitalaria y complicaciones respiratorias. La recuperación inadecuada se clasificó de acuerdo con la escala de agitación y sedación de Richmond 10 minutos después del ingreso en la unidad. Resultados. La incidencia de bloqueo neuromuscular residual en la URPA fue de 29,7% (Intervalo de Confianza 95%: 23,4 - 36,1). Los pacientes con bloqueo residual tuvieron eventos respiratorios críticos, considerados de forma global con mayor frecuencia (51% frente 16%, p<0,001), obstrucción de vía aérea (10% frente 2%, p=0,029), hipoxemia leve-moderada (23% frente 4%, p<0,001), hipoxemia grave (7% frente 1%, p=0,033), insuficiencia respiratoria(8% frente 1%, p=0,031), incapacidad para respirar profundamente (38% frente 12%, p<0,01) y debilidad muscular (16% frente 1%, p<0,001). El bloqueo neuromuscular residual fue más frecuente después de cirugía de alto riesgo (53% frente 33%, p=0,011) y se asociaba más a menudo con recuperación anestésica hipoactiva según lo definido por la escala de agitación y sedación de Richmond (21% frente 6%, p=0,001). Conclusiones. Este estudio sugiere que el bloqueo neuromuscular residual es común en la URPA y se asocia a mayor frecuencia de incidentes respiratorios críticos(AU)

Objective. Residual neuromuscular block is an important postoperative complication associated to the use of neuromuscular blocking drugs. The purpose of this study was to access the incidence of residual neuromuscular block in a post-anesthesia care unit and to evaluate its association with critical respiratory events. Material and methods. Prospective cohort study was conducted in a Post Anesthetic Care Unit (PACU) for a period of 3 weeks. Two hundred two adult patients who submitted to scheduled non-cardiac and non-intracranial surgery were eligible to the study. The primary outcome variable was residual neuromuscular block after arrival to PACU that was defined as train-of-four ratio <0.9 and objectively quantified using acceleromyography. Demographic data, perioperative variables, lengths of hospital and recovery room stay and critical respiratory events were recorded. Inadequate emergence was classified in its different forms according to the Richmond agitation and sedation scale 10min after admission to the recovery room. Results. Residual neuromuscular block incidence in the post-anesthesia care unit was 29.7% (95% confidence interval: 23.4, 36.1). Patients with residual neuromuscular block had more frequently overall critical respiratory events (51% versus 16%, P<0.001), airway obstruction (10% versus 2%, P=0.029), mild-moderate hypoxemia (23% versus 4%, P<0.001), severe hypoxemia (7% versus 1%, P=0.033), respiratory failure (8% versus 1%, P=0.031), inability to breathe deeply (38% versus 12%, P<0.001) and muscular weakness (16% versus 1%, P<0.001). Residual neuromuscular block was more common after high-risk surgery (53% versus 33%, P=0.011) and was more often associated with post-operative hypoactive emergence as defined by the Richmond Agitation and Sedation Scale (21% versus 6%, P=0.001). Conclusions. This study suggests that residual neuromuscular block is common in the PACU and is associated with more frequent critical respiratory events(AU)

Residual neuromuscular block as a risk factor for critical respiratory events in the post anesthesia care unit.

OBJECTIVE: Residual neuromuscular block is an important postoperative complication associated to the use of neuromuscular blocking drugs. The purpose of this study was to access the incidence of residual neuromuscular block in a post-anesthesia care unit and to evaluate its association with critical respiratory events. MATERIAL AND METHODS: Prospective cohort study was conducted in a Post Anesthetic Care Unit (PACU) for a period of 3 weeks. Two hundred two adult patients who submitted to scheduled non-cardiac and non-intracranial surgery were eligible to the study. The primary outcome variable was residual neuromuscular block after arrival to PACU that was defined as train-of-four ratio <0.9 and objectively quantified using acceleromyography. Demographic data, perioperative variables, lengths of hospital and recovery room stay and critical respiratory events were recorded. Inadequate emergence was classified in its different forms according to the Richmond agitation and sedation scale 10 min after admission to the recovery room. RESULTS: Residual neuromuscular block incidence in the post-anesthesia care unit was 29.7% (95% confidence interval: 23.4, 36.1). Patients with residual neuromuscular block had more frequently overall critical respiratory events (51% versus 16%, P<0.001), airway obstruction (10% versus 2%, P=0.029), mild-moderate hypoxemia (23% versus 4%, P<0.001), severe hypoxemia (7% versus 1%, P=0.033), respiratory failure (8% versus 1%, P=0.031), inability to breathe deeply (38% versus 12%, P<0.001) and muscular weakness (16% versus 1%, P<0.001). Residual neuromuscular block was more common after high-risk surgery (53% versus 33%, P=0.011) and was more often associated with post-operative hypoactive emergence as defined by the Richmond Agitation and Sedation Scale (21% versus 6%, P=0.001). CONCLUSIONS: This study suggests that residual neuromuscular block is common in the PACU and is associated with more frequent critical respiratory events.