Key result
Post-spinal FEV1 drop of ≥10% linked to ~13.6-fold higher risk of intraoperative hypoxia.
Why the study?
Spinal anesthesia is associated with multiple intraoperative complications, and the role of reduction in FEV1 in these cardiopulmonary complications is unclear.
Does a reduction in FEV1% predicted of ≥ 10% following spinal anesthesia predict intraoperative cardiopulmonary complications in patients without primary cardiopulmonary disease?
Cohort (n=48)
No
Does a reduction in FEV1% predicted of ≥ 10% following spinal anesthesia predict intraoperative cardiopulmonary complications in patients without primary cardiopulmonary disease?
Odds Ratio: 13.55 (95% CI 1.07–171.24)
p-value: p=0.044
A reduction in FEV1 of 10% or more following spinal anesthesia identifies patients at significantly higher risk for intraoperative hypoxia.
ΔFEV1 ≥10% may flag hypoxia risk during spinal anesthesia; hypothesis-generating and requires validation before any practice change.
Background and Aims Although Spinal Anesthesia (SA) remains the technique of choice for many surgeries below the umbilicus, it is associated with multiple intraoperative complications. Sympathetic blockade and Bezold‐Jarisch reflex do not fully explain SA‐related cardiopulmonary complications. Reduction in FEV1 has been reported as a predictor of sudden cardiac death. This study aimed to determine the association between reduction in FEV1 following SA and adverse intraoperative cardiopulmonary complications. Materials and Methods A prospective study of 48 patients of ASA status I and II with no history of primary cardiopulmonary disease scheduled for elective surgery under SA. Spirometry was performed based on ATS/ERS guidelines before induction and 30 min after induction of SA. FEV1% predicted was determined using GLI 2012 equations. Participants were grouped into two (∆FEV1% < 10% and ∆FEV1% ≥ 10%) based on reductions (∆) in FEV1% predicted following SA. Logistic regression analyses were used to examine associations between ∆FEV1% and intraoperative hypoxia, hypotension, bradycardia, and nausea/vomiting, with adjustments for age, gender, and BMI. Results The mean FEV1% predicted following SA was lower than the mean FEV1% predicted before SA (83.42 vs. 95.31, p = 0.001). In a fully adjusted model, ∆FEV1% ≥ 10% was associated with an increased risk of hypoxia [AOR 13.55; 95% CI, 1.07–171.24, p = 0.044]. The positive associations between ∆FEV1% ≥ 10% and hypotension [2.02 (0.33–12.46), 0.449], bradycardia [1.10 (0.28–4.25), 0.895] and nausea/vomiting [9.74 (0.52–183.94), 0.129] were not statistically significant. Conclusion Reduction in FEV1% predicted following SA was associated with adverse intraoperative outcomes. FEV1 may play an important role in the association between SA and cardiopulmonary complications.
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Agyei‐Fedieley et al. (2024) conducted a cohort in Elective surgery under spinal anesthesia (n=48). Reduction in FEV1% predicted ≥ 10% following spinal anesthesia vs. Reduction in FEV1% predicted < 10% was evaluated on Intraoperative hypoxia (AOR 13.55, 95% CI 1.07-171.24, p=0.044). A reduction in FEV1% predicted of 10% or more following spinal anesthesia was associated with a 13.55-fold increased risk of intraoperative hypoxia (AOR 13.55, 95% CI 1.07-171.24, p=0.044).
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