Guideline for the use of Oxygen for patients transferred from theatre to recovery.

Author: Dr Martina Bieker Consultant Anaesthetist

Sponsor: The Directorate of Anaesthesia

Introduction

Patients who have undergone surgery are vulnerable to develop hypoxia unless supplementary oxygen is given. Patients especially at risk are the elderly, children, the obese and patients with cardiopulmonary disease. The duration and type of surgery as well as the type of anaesthetic may also predispose patients to hypoxia on transfer. Most patients are still unconscious when they are transferred and their breathing may be shallower than normal.

Reason for the development of the guideline

A national guideline exists.

Methodology

The Association of Anaesthetists of Great Britain and Ireland has produced a guideline on “ Immediate post anaesthetic Recovery” in 2002. In it is stated that “supplementary oxygen should be administered to all patients during transfer”.

Research done on 132 patients being transferred from theatre to the recovery unit showed that oxygen saturations dropped to 85% or less in 21.9 patients and to 90% or less in 61.4% when not given supplementary oxygen. The authors recommend giving oxygen to all patients, as they were unable to identify who was at risk of hypoxia. Anaesthesia: 1987 Dec; (42) 12 1313-5

Implementation

Increase awareness among anaesthetists and theatre staff of the occurrence of hypoxia. Mention this guideline in department meeting. Posters for theatres.

Oxygen cylinders are available in theatres and recovery units - empty cylinders have to be changed on a regular basis. The sister in charge of main recovery currently ensures a stock of cylinders is available.

Monitoring

Audit the use of oxygen for transfer.

100% of patients should be transferred on oxygen according to the national guideline.

Application of the guideline

Will benefit patients. There is evidence that postoperative nausea and vomiting is decreased when supplementary oxygen is given. Hypoxia may precipitate more serious complications for patients and avoiding low saturations may prevent this.

There should not be exceptions – individual professionals may decide not to follow the guideline if it is not necessary in their judgement.

Objectives

To remind anaesthetist of the occurrence of hypoxia in postoperative patients and to encourage them to provide supplementary oxygen.

Guideline Steps

  • Provide guideline
  • Discussion at directorate meeting
  • Discussion at theatre staff meeting
  • Provide reminders in the form of posters for theatre
  • Audit the use of oxygen for transfer after 3 months

Alternative methods – not to give oxygen

Possible risks – none

References

As mentioned above.