Pulse oximetry for perioperative monitoring
Abstract
Background
Monitoring with pulse oximetry might improve patient outcome by enabling an early diagnosis and consequently, correction of perioperative events that might cause postoperative complications or even death. Only a few randomized clinical trials of pulse oximetry have been performed during anaesthesia, and in the recovery room which describe perioperative hypoxaemic events, postoperative cardiopulmonary complications and cognitive dysfunction.
Objectives
The objective of this review was to assess the effect of perioperative monitoring with pulse oximetry and to clearly identify the adverse outcomes that might be prevented or improved by the use of pulse oximetry.
Search methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), (The Cochrane Library 2005, issue 1), MEDLINE (1966 to January 2005), EMBASE (1980 to January 2005), and checked the reference lists of trials and review articles.
Selection criteria
We included all controlled trials that randomized patients to either pulse oximetry or no pulse oximetry during the perioperative period.
Data collection and analysis
Two authors independently assessed data in relation to events detectable by pulse oximetry, any serious complications that occurred during anaesthesia or in the postoperative period, and intra‐ or postoperative mortality.
Main results
Searching identified six reports. We considered four studies with data from a total of 21,773 patients, eligible for analysis. Results indicate that hypoxaemia was reduced in the pulse oximetry group both in the operating theatre and in the recovery room. During observation in the recovery room, the incidence of hypoxaemia in the pulse oximetry group was 1.5 to 3 times less. The postoperative cognitive function was independent of perioperative monitoring with pulse oximetry. The other study showed that postoperative complications occurred in 10% of the patients in the oximetry group and in 9.4% in the control group. No statistically significant differences were detected in cardiovascular, respiratory, neurologic, or infectious complications in the two groups. The duration of hospital stay was a median of five days in both groups, and an equal number of in‐hospital deaths was registered in the two groups.
Authors' conclusions
The studies confirmed that pulse oximetry can detect hypoxaemia and related events. However, we have found no evidence that pulse oximetry affects the outcome of anaesthesia. The conflicting subjective and objective results of the studies, despite an intense, methodical collection of data from a relatively large population, indicate that the value of perioperative monitoring with pulse oximetry is questionable in relation to improved reliable outcomes, effectiveness and efficiency.
Plain language summary
Perioperative monitoring with pulse oximetry does not appear to affect the outcome of anaesthesia
The pulse oximeter is a non‐invasive clinical monitor that measures the oxygen saturation of blood. Although pulse oximetry can detect a deficiency of oxygen in the blood, its use does not appear to influence a person's cognitive function, length of hospital stay or incidence of complications after anaesthesia.
