Background: In an effort to prevent and address perioperative hypoxemia, it has become customary to provide supplemental oxygen to all surgical patients. Recently, the value of such a practice has been questioned. This study was designed to determine the incidence as well as the potential risk factors associated with perioperative hypoxemia. Methods: During a 9 - week period, 84 ASA I-II patients who underwent ambulatory surgical procedures under spinal anesthesia were observed. Arterial oxygen saturation (SpO2) was monitored using a pulse oximeter prior to induction of anesthesia, during operation and until the patient was discharged from the recovery room. Patients breathed room air during the entire perioperative course unless dyspnea and/or desaturation occurred. Descriptive statistics was used to examine differences in oxygen saturations before, during, and after surgery. The association between each of the potential risk factors and the number of patients requiring supplemental oxygen was analyzed using Fisher's exact test (for attribute data e.g. level of sensory block) and the Wilcoxon's rank sum test for continuous data (e.g. age, smoking in pack years) to calculate the probability that the proportions did not differ. A/>< 0.05 was considered statistically significant. Results: The incidence of preoperative, intra-operative and postoperative hypoxemia was 0 percent, 0 percent and 1.14 percent respectively while the need for supplemental oxygen was 2.27 percent intra-operatively and 2.27 percent postoperatively. Statistical analysis revealed that the level of block and body mass index were significant factors (P < 0.05) influencing the need for oxygen support. The need for supplemental oxygen was not associated with age, smoking history, surgical position, sedation level and Visual Analog Scale score. Conclusion: Results suggest that seemingly healthy patients who undergo lower abdominal, urologic, gynecologic or lower extremity surgical procedures under spinal anesthesia are at a low risk for hypoxemia. Pulse oximetry as part of routine monitoring may obviate the need for supplemental oxygen in this patient population. (Author)
Human ; ANESTHESIA ; ANOXEMIA ; OXIMETRY ; ANESTHESIA, SPINAL ; AMBULATORY SURGICAL PROCEDURES

Background:The FLACC (Facial expression, Leg movement, Activity, Cry, Consalability) behavioral pain assessment scale was developed and validated by Merkel and colleagues among American children last 1997 for autepain assessment of children 2 months to 7 years of age. Since then, it has been validated among other nationalities. It is now being used in Scotland, Australia, Canada and Thailland. This study aimed to determine the inter-reter reliability and construct validity of the FLACC on Filipino posoperative pediatric patients. Methods: A total of 106 children less than 5 years of age (1,68+1.46 years) who were admitted in the Philippine General Hospital Post Anesthesia Care Unit (PACU) were included. Those who are operated on an emergency basis, had neurologic impairment, had developmental delay and required menchanical ventilation postoperatively were excluded. Prior to the data collection phase, the PACU nurses were trained to use the FLACC scale using videotapes of postoperative children. Whenever possible, children were silmultaneuosly rated by two idependent ratersdurig their stay in the PACU. Those with FLACC scores>4 were given an intervention and the pain measurement was repeated and reported accordingly. Results: Inter-rater reliability was good to very good with kappa values for the pain behavior items ranging from 0.75 to 0.82. Construct validity ws established by showing a statistically significant reduction (p<0.001) beteen the pre-intervention score and post-intervention score using Wilcoxon signed rank test. Conclusion: The FLACC exhibited bith inter-rater reliability and contruct validity in the measurement of acute postoperative pain in Filipino children less than 5 years old.
Human ; Child Preschool ; Infant ; PAIN MEASUREMENT ; PAIN ; PEDIATRICS ; PAIN, POSTOPERATIVE

Background: The aims of this study were to determine the average length of stay in the Post-anesthesia Care Unit (PACU LOS) in the Philippine General Hospital (PGH) and to create a model that will predict the PACU LOS based on the factors that significantly affect the LOS. Determination and prediction of PACU LOS is essential in resource utilization, and in cost containment and reduction. Addressing the modifiable variables that affect the PACU LOS may lead to an improvement in the LOS of patients in the PACU and, consequently, to better recovery room staffing and a reduced cost for the patients and the hospital. Methods: A prospective chart review of 400 postoperative patients admitted in the PGH PACU was done. Summary statistics were presented. Using the set of variables found to be significant, a regression model was formulated to estimate the PACU LOS. Results: The mean PACU LOS was 4.59 hours. There were significant differences in the mean PACU LOS based on the occurrence of complications. There were also significant differences in the median PACU LOS based on the type and duration of surgery, anesthetic technique, and duration of anesthesia. The multiple linear regression model that best predicted PACU LOS included ASA-PS classification, type of surgery, duration of surgery, anesthetic technique, and occurrence of intraoperative or postoperative complications. Conclusions The mean PACU LOS of the Philippine Genera Hospital is higher than that of published data. The factors included in the model that best predicts PACU LOS may be studied to improve the PACU LOS.
Length of Stay ; Anesthesia ; Anesthesiology ; Regression Analysis