Key result
Preoperative hypoxia linked to ~20-fold higher intraoperative desaturation risk in adults.
Why the study?
The incidence of desaturation during general anesthesia in preoperatively hypoxic versus nonhypoxic pediatric and adult patients was not well characterized.
Does preoperative hypoxia increase the risk of intraoperative desaturation during general anesthesia in adult and pediatric patients?
Cohort (n=6,228)
No
Does preoperative hypoxia increase the risk of intraoperative desaturation during general anesthesia in adult and pediatric patients?
Relative Risk: 20.1 (95% CI 10.3–39.2)
Absolute Event Rate: 13.5% vs 0.7%
p-value: p=<0.001
Preoperative hypoxia is a strong predictor of intraoperative desaturation during general anesthesia, particularly in adult patients, highlighting the need for baseline pulse-oximetry checks.
Preoperative hypoxia flags elevated desaturation risk; supports SpO2 screening but leaves open whether correction improves outcomes in trials.
We investigated the incidence of desaturation during general anesthesia in preoperatively hypoxic (< 92%), and nonhypoxic (≥ 92%) pediatric (n=1,090) and adult (n=5,138) patients. We plotted the patients' SpO2 value time-courses and assessed desaturation in 6,228 patients. The crude overall incidence (95%CI) for desaturation was 11.1% (9.4-13.1) in the pediatric patients and 0.9% (0.6-1.2) in the adults. The crude incidence of desaturation in the hypoxic pediatric patients was 2.5 times the risk in the nonhypoxic patients: risk ratio (RR) 2.5 (1.8-3.5), p<0.001. The risk of desaturation in the hypoxic adult patients was 20.1 times the risk in the nonhypoxic adult patients: RR 20.1 (10.3-39.2), p<0.001. When the patients were separately stratified by American Society of Anesthesiologists Physical Status (ASA-PS) and by age, the directly adjusted risk-ratio (RRS) showed that the hypoxic pediatric patients had 1.8 and 1.6 times the risk in the nonhypoxic pediatric patients: ASA-PS adjusted RRS 1.6 (1.8-2.2), p<0.001; age-adjusted RRS 1.8 (1.3-2.5), p<0.001, and the hypoxic adult patients had 13.8 times the risk in the nonhypoxic adult patients: RRS 13.8 (6.9-27.6), p<0.001. A pulse-oximeter check before the start of general anesthesia could ensure timely preparation to avoid intraoperative desaturation.
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Lemoto et al. (2018) conducted a cohort in Patients undergoing general anesthesia (n=6,228). Preoperative hypoxia (SpO2 < 92%) vs. Preoperative nonhypoxia (SpO2 ≥ 92%) was evaluated on Incidence of intraoperative desaturation during the first 45 minutes of general anesthesia in adult patients (RR 20.1, 95% CI 10.3-39.2, p=<0.001). Preoperative hypoxia (SpO2 < 92%) significantly increased the risk of intraoperative desaturation compared to nonhypoxic patients, with a 20.1-fold higher risk in adults and a 2.5-fold higher risk in pediatric patients.
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