J Rosenberg1, H Kehlet. 1. Department of Surgical Gastroenterology, Hvidovre University Hospital, Denmark.
Abstract
BACKGROUND: Postoperative confusion is a well-known complication, but the pathogenetic mechanisms, of which hypoxemia may be one, are not completely understood. METHODS: Thirty otherwise healthy patients undergoing major abdominal surgery and ten patients undergoing middle ear minor surgery, all under general anesthesia, were monitored for oxygen saturation (SpO2) with a pulse oximeter on a preoperative night and on the second night after operation (11:00 PM to 7:00 AM). All patients were tested with a mental test questionnaire (the Hodkinson modification of the original Roth-Hopkins test) before operation and on the third and seventh day after operation. RESULTS: Postoperative hypoxemia did not develop in patients undergoing minor surgery, whereas major surgery was associated with severe constant and episodic hypoxemia on the second postoperative night (p < 0.05). The patients undergoing major surgery had decreased mental function on the third day (p < 0.05) but not on the seventh day after operation, whereas minor surgery did not impair mental function. There was a significant correlation between mental function on the third day after operation and mean SpO2 on the second postoperative night after major surgery (rs = 0.53, p < 0.005) and minor surgery (rs = 0.74, p < 0.03). After major surgery there was also a correlation between decrease (preoperative to postoperative) in mental function on the third postoperative day and mean SpO2 on the second postoperative night (rs = -0.40, p < 0.04). During stepwise multiple regression analysis in patients undergoing major surgery, a significant relationship was found between postoperative mental test score and SpO2 (p < 0.05) but not between mental function and other perioperative variables (age, premedication dose, duration of operation, and intraoperative and postoperative opioid dose). CONCLUSIONS: These results suggest postoperative hypoxemia to be an important pathogenetic factor in postoperative mental dysfunction.
BACKGROUND:Postoperative confusion is a well-known complication, but the pathogenetic mechanisms, of which hypoxemia may be one, are not completely understood. METHODS: Thirty otherwise healthy patients undergoing major abdominal surgery and ten patients undergoing middle ear minor surgery, all under general anesthesia, were monitored for oxygen saturation (SpO2) with a pulse oximeter on a preoperative night and on the second night after operation (11:00 PM to 7:00 AM). All patients were tested with a mental test questionnaire (the Hodkinson modification of the original Roth-Hopkins test) before operation and on the third and seventh day after operation. RESULTS:Postoperative hypoxemia did not develop in patients undergoing minor surgery, whereas major surgery was associated with severe constant and episodic hypoxemia on the second postoperative night (p < 0.05). The patients undergoing major surgery had decreased mental function on the third day (p < 0.05) but not on the seventh day after operation, whereas minor surgery did not impair mental function. There was a significant correlation between mental function on the third day after operation and mean SpO2 on the second postoperative night after major surgery (rs = 0.53, p < 0.005) and minor surgery (rs = 0.74, p < 0.03). After major surgery there was also a correlation between decrease (preoperative to postoperative) in mental function on the third postoperative day and mean SpO2 on the second postoperative night (rs = -0.40, p < 0.04). During stepwise multiple regression analysis in patients undergoing major surgery, a significant relationship was found between postoperative mental test score and SpO2 (p < 0.05) but not between mental function and other perioperative variables (age, premedication dose, duration of operation, and intraoperative and postoperative opioid dose). CONCLUSIONS: These results suggest postoperative hypoxemia to be an important pathogenetic factor in postoperative mental dysfunction.
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