Wickerts Liselott, Forsberg Sune, Bouvier Frederic, Jakobsson Jan
Department of Anaesthesia, Norrtälje hospital, TioHundra AB, Norrtälje, Sweden.
Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
F1000Res. 2017 May 22;6:735. doi: 10.12688/f1000research.11519.2. eCollection 2017.
: Obstructive sleep apnoea and obese hypoventilation is not uncommon in patients with obesity. Residuals effect from surgery/anaesthesia and opioid analgesics may worsen respiration during the first nights after bariatric surgery. The aim of this observational study was to monitor respiration on the first postoperative night following elective bariatric surgery. : This observational study aimed to determine the incidence and severity of hypo/apnoea in low risk obsess patients undergoing elective bariatric surgery in general anesthaesia. Patients with known or suspected sleep respiratory disturbances was not included. ESS was scored prior to surgery. Oxygen desaturation was analyzed by continuous respiratory monitoring. Mean oxygen saturation (SpO2), nadir SPo2, apnoea/hypopnea index and oxygen desaturation index was assess by standard tools. : 45 patients were monitored with portable polygraphy equipment (Embletta, ResMed) during the first postoperative night at the general ward following elective laparoscopic bariatric surgery. The prop ESS was 0-5 in 22, 6-10 in 14 and 11-16 in 6 of the patients studied (missing data 3). Mean SpO2 was 93%; 10 patients had a mean SpO2 of less than 92% and 4 of less than 90%. The lowest mean SpO2 was 87%. There were 16 patients with a nadir SpO2 of less than 85%, lowest nadir SpO2 being 63%. An Apnoea Hypo/apnoea Index (AHI) > 5 was found in 2 patients only (AHI 10 and 6), and an Oxygen Desaturation index (ODI) > 5 was found in 3 patients (24, 10 and 6, respectively). 3 patients had more prolonged (> 30 seconds) apnoea with nadir SpO2 81%, 83% and 86%. ESS score and type of surgery did not impact on respiration/oxygenation during the observation period. : A low mean SpO2 and episodes of desaturation were not uncommon during the first postoperative night following elective bariatric surgery in patients without history of night time breathing disturbance. AHI and/or ODI of more than 5 were only rarely seen. Night-time respiration monitoring provided seemingly sparse additional information. Further studies are need to assess risk factors and potential impact of the desaturation episodes that occurs during sleep.
阻塞性睡眠呼吸暂停和肥胖低通气在肥胖患者中并不少见。手术/麻醉和阿片类镇痛药的残留效应可能会使减重手术后的头几个晚上呼吸情况恶化。这项观察性研究的目的是监测择期减重手术后第一个术后夜晚的呼吸情况。
这项观察性研究旨在确定在全身麻醉下接受择期减重手术的低风险肥胖患者中呼吸浅促/呼吸暂停的发生率和严重程度。已知或疑似存在睡眠呼吸障碍的患者未纳入研究。术前进行了爱泼沃斯思睡量表（ESS）评分。通过持续呼吸监测分析氧饱和度下降情况。使用标准工具评估平均血氧饱和度（SpO2）、最低SpO2、呼吸暂停/低通气指数和氧饱和度下降指数。
45例患者在择期腹腔镜减重手术后的第一个术后夜晚于普通病房使用便携式多导睡眠图设备（Embletta，瑞思迈公司）进行监测。在研究的患者中，ESS评分0 - 5分的有22例，6 - 10分的有14例，11 - 16分的有6例（3例数据缺失）。平均SpO2为93%；10例患者的平均SpO2低于92%，4例低于90%。最低平均SpO2为87%。有16例患者的最低SpO2低于85%，最低值为63%。仅2例患者的呼吸暂停低通气指数（AHI）> 5（分别为10和6），3例患者的氧饱和度下降指数（ODI）> 5（分别为24、10和6）。3例患者出现更长时间（> 30秒）的呼吸暂停，最低SpO2分别为81%、83%和86%。在观察期内，ESS评分和手术类型对呼吸/氧合情况没有影响。
在没有夜间呼吸障碍病史的患者中，择期减重手术后的第一个术后夜晚平均SpO2较低和出现氧饱和度下降的情况并不少见。AHI和/或ODI大于5的情况仅很少见。夜间呼吸监测提供的额外信息似乎很少。需要进一步研究来评估睡眠期间发生的氧饱和度下降事件的风险因素和潜在影响。
