The purpose of this descriptive study was to evaluate, through clinical testing, the interrater reliability and concurrent validity of the Interchange of Gases Assessment Tool (IGAST) for monitoring the respiratory status of patients in the Postanesthesia Care Unit. The IGAST was used to assess the respiratory status of 20 patients over three time periods (60 data samples). Findings indicated that interrater reliability of the IGAST was acceptable for clinical use in the PACU. The IGAST received a mean interrater reliability rating of 98% in the PACU setting. Results of the mean dimension scores supported the patients' readiness for discharge. Chart audit revealed that the IGAST had concurrent validity since charted information and rated IGAST items were congruent. Further findings suggested that nurses using the IGAST document the respiratory status of patients more completely and more consistently than nurses using narrative documentation.

A prevalência de LRA no pós-operatório (PO) de cirurgia cardíaca varia em torno de 5% a 31%, dependendo da população estudada e do critério adotado para sua definição. Os objetivos deste estudo foram classificar a função renal de pacientes em pós-operatório de cirurgia cardíaca, utilizando o sistema classificador RIFLE (R="risk", I="injury", F="failure", L= ‘loss" e E="end-stage") e avaliar o desempenho discriminatório de um marcador de taxa de filtração glomerular, a Cistatina C (CC). A amostra compôs-se de 121 pacientes, sem história de lesão renal prévia, acompanhados nas 24 , 48 e 72 horas. Os desfechos considerados foram alta ou óbito no PO. O RIFLE foi utilizado para comparação com demais variáveis, bem como dois de seus componentes, a creatinina plasmática e o clearance de creatinina. As categorias “R", “I" e “F" do RIFLE foram consideradas como LRA. A idade média dos pacientes foi de 50 anos, com 61,2% de sexo masculino, 38,8% de sexo feminino e predomínio da raça branca (92%). A cirurgia valvar foi a mais realizada (48,8%), seguida de 43,8% de revascularização do miocárdio e 7,4% de cirurgias combinadas, sendo que em 78% dos pacientes foi adotada a circulação extracorpórea com duração máxima de 120 minutos. A grande maioria (97,5%) dos pacientes obteve alta hospitalar. A LRA ocorreu em 78,5% pelo critério RIFLE. Quanto à CC, constatou-se relação de seus níveis com a piora da função renal vista pelo RIFLE nos períodos estudados. A CC apresentou maior sensibilidade e especificidade do que a Creatinina (Cr) para sinalização de piora da função renal com área sob a curva (0,67 vs 0,62). O estudo confirmou melhor desempenho da CC para detecção de LRA do que a Cr em PO da cirurgia cardíaca / The prevalence of acute kidney injury (AKI) in the postoperative period of cardiac surgery ranges from 5 to 31%, depending on the population studied and the criteria used for its definition. The objectives of this study were to classify the renal function of the patients in the postoperative period of cardiac surgery according to the RIFLE classification (Risk, injury, Failure, Loss and End-stage) and to assess the discriminating power of a glomerular filtration rate marker, the Cystatin C (CC). The sample was composed by 121 patients, with no kidney failure history, who were followed up 24, 48 and 72 hours after surgery. The outcome considered were hospital discharge or death. RIFLE was used as basis to compare the other variables, as well as two of its components: the Serum Creatinine (Cr) and the Creatinine Clearance. Patients classified as “R", “I" and “F" were considered with AKI. The mean age of the patients was 50 years, with 61.2% of males, 38.8% of females and a preponderance of Caucasians (92%). The valve surgery was the most performed surgery (48.8%), followed by 43.8% of myocardial revascularization and 7.4% of combined surgery. In 78% of the cases, a coronary artery bypass grafting was adopted and lasted 120 minutes time or less. The great majority (97.5%) of the patients were discharged from hospital. The AKI occurred in 78.5% of the sample using the RIFLE criteria. Regarding the CC, it was noticed a relationship between its levels and the worsening of the renal function, according to RIFLE, in the studied period. The CC presented a higher sensibility and specificity than Cr to signal the worsening of the renal function (area under the curve 0.67 vs. 0,62). The study confirmed a better performance of the CC than the Cr marker to detect AKI in the postoperative period of cardiac surgery

Uma das manifestações mais comuns em sala de recuperação anestésica é a náusea, geralmente associada à anestesia. Além do aspecto subjetivo do desconforto, os pacientes que não apresentam melhora desse sintoma podem ter alta retardada, tanto da sala de recuperação anestésica quanto hospitalar. Como conseqüências, temos a demora do retorno às funções normais, a elevação dos custos hospitalares e um menor grau de satisfação do paciente. O objetivo do presente estudo foi realizar uma análise crítica das evidências disponíveis na literatura sobre os fatores relacionados e características definidoras do diagnóstico de enfermagem náusea, no período pós-operatório imediato, por meio de uma revisão integrativa. No desenvolvimento deste estudo, utilizaram-se como fonte de levantamento de dados quatro base de dados: Lilacs, Pubmed, Cinahl e Cochrane - Revisões Sistemáticas, e a amostra constituiu-se de 31 estudos. A análise das publicações selecionadas demonstrou que as náuseas e vômitos no período pós-operatório são considerados eventos relacionados e, na maioria das vezes, avaliados como um evento único. Os fatores relacionados identificados, de acordo com a freqüência de aparecimento e nível de evidência, foram: sexo feminino, não fumante, história prévia de náuseas e vômitos no pós-operatório, história de náusea associada ao movimento, idade, tipo de cirurgia, uso de opióides no trans e pós-operatório, uso de anestésicos voláteis e administração de óxido nitroso. Em relação às características definidoras evidenciamos nos estudos analisados: palidez, taquicardia, aumento na salivação, transpiração, sensação de calor e frio, rubor, consciência do impulso do vômito, tonturas, bradicardia, dilatação pupilar, variações na pressão arterial, respiração profunda, rápida e irregular. A importância de aperfeiçoar e legitimar os elementos que fazem parte da Taxonomia II da NANDA (2006) está em possibilitar aos profissionais enfermeiros que atuam em centro cirúrgico e recuperação pós-anestésica o planejamento da assistência de enfermagem ao paciente nos três períodos da experiência cirúrgica, visando à minimização das complicações no pósoperatório e promover uma reabilitação mais rápida e tranqüila. / Nausea is one of the most common adverse events in the pots-anesthesia recovery room. It is usually associated to anesthesia. Besides the subjective aspect it can be very distressing for patients. The patients who are suffering from nausea and do show any improvement at all may have a late discharge from both the post-anesthesia recovery room and the hospital. The delayed return to normal functions, the high hospital costs, and the lower degree of the patient\'s satisfaction are some of the consequences. The aim of the present study was to perform a critical analysis of the available evidences in the literature about the related factors and the defining characteristics of nursing diagnosis nausea over the immediate postoperative period by means of an integrative review. During the development of this study systematic reviews and four databases for data collection were used: Lilacs, Pubmed, Cinahl, and Cochrane. From the screened reports, 31 of those were potentially relevant for the purpose of this study. The analysis of the retrieved studies showed that vomiting and nausea in the postoperative period are considered to be closely related and most of the time no distinction can be made between nausea and vomiting. The identified factors related according to the rate of appearance and evidence level were the following: female gender, non-smoking, prior history of vomiting and nausea in the postoperative period, history of nausea associated to motion, age, type of surgery, opioid use in a trans- and a postoperative period, use of volatile anesthetics, and nitrous oxide administration. In relation to the defining characteristics we highlighted the following: pallor, tachycardia, an increased secretion of saliva (sialorrhea, salivation), and perspiration, sensation of cold and heat, blush, awareness of the vomiting impulse, dizziness, bradycardia, pupillary dilation, arterial blood pressure changes, deep, fast, and irregular breathing. The importance to improve and to validate the NANDA\'s Taxonomy II (2006) elements is to enable the registered nurses, who work at surgery centers and anesthesia recovery rooms, to plan the nursing care for the patient in the 3-period of surgical experience aiming at to minimizing the complications in the postoperative period and to stimulate a fast and an undisturbed rehabilitation.

Delirium é um estado confusional agudo caracterizado por um distúrbio de consciência, alteração na cognição e curso flutuante ao longo do dia. É a complicação mais comum observada em idosos hospitalizados. É freqüente no pós-operatório de cirurgia cardíaca, e pode chegar a taxas tão altas quanto 73% em pacientes mais idosos. Pacientes com delirium apresentam maior risco de morte, demência e institucionalização, aumento do tempo de internação hospitalar e dos custos. Os objetivos deste estudo foram: 1) determinar a incidência do delirium no pós-operatório de cirurgia cardíaca em idosos; 2) identificar fatores predisponentes e precipitantes neste contexto; 3) avaliar a relação entre delirium e morbimortalidade por até 18 meses de seguimento. Este estudo foi observacional, prospectivo, tipo coorte, realizado no Hospital de Messejana no período de Setembro/2011 à Dezembro/2013. Foram estudados 173 pacientes com idade > 60 anos. Antes da cirurgia, os pacientes foram avaliados quanto à função cognitiva através do MEEM e TFV, e pelo CAM, para determinar a presença de delirium pré-operatório, motivo de exclusão do estudo. Foram registradas variáveis referentes aos dados demográficos, doenças prévias, medicações utilizadas, e calculado o risco de mortalidade cirúrgica para cada paciente através do EuroSCORE II. Resultados de exames pré-operatórios como ECG, ecodopplercardiograma, cateterismo cardíaco, Doppler de carótidas e exames laboratoriais também foram registrados. Durante a cirurgia, as variáveis avaliadas foram o tempo de CEC e clampeamento de aorta, duração da cirurgia e anestesia e uso de hemoderivados. Como variáveis pós-operatórias foram analisados o TIOT, tempo de permanência na UTI, presença de disfunção renal, hipoxemia. O delirium foi avaliado pelo CAM-ICU no pós-operatório. Para o desfecho composto foram registrados óbitos por todas as causas, infecções e IAM perioperatório identificados até a alta hospitalar ou 30 dias após a cirurgia. Os pacientes foram seguidos por um período de 12 a 18 meses e registrados eventos como óbitos, reinternações e demência, através de nova avaliação com MEEM e TFV. Após análise univariada foi realizada análise multivariada por regressão logística múltipla para identificar as variáveis independentes. A idade média dos pacientes foi 69,5 + 5,8. Cerca de 75,14% eram hipertensos e 39,88% eram diabéticos. A média do EuroSCORE II foi 4,06 + 3,86. Cerca de 30,06% eram analfabetos. A média do grau de escolaridade foi 3,05 + 3,08 anos. A incidência do delirium foi 34,1%. Em 70% dos casos, o delirium foi detectado nos dois primeiros dias após a cirurgia. Foram identificados o grau de escolaridade (OR = 0,81; IC 95% 0,71 - 0,92; p=0,002), HAS (OR = 2,73; IC 95% 1,16 - 6,40; p=0,021) e a presença de valvopatia mitral ( OR = 2,93; IC 95% 1,32 - 6,50; p=0,008) como fatores predisponentes independentes para delirium. Como fator precipitante independente foi identificado o tempo de internação na UTI com OR=1,18; IC 95% 1,07 - 1,30 e p=0,001. O delirium foi fator de risco independente para o desfecho composto com OR=2,35; IC 95% 1,20 - 4,58 e p=0,012, além do TIOT > 900 minutos (OR=2,50; IC 95% 1,30 - 4,80; p=0,006) após análise multivariada. Não houve relação entre delirium e óbito após alta hospitalar, demência ou taxa de reinternação durante o seguimento / Delirium is an acute and transient syndrome with features of inattention and global cognitive dysfunction over the time. Among elderly hospitalized patients is the most common complication. The postoperative cardiac surgery delirium occurs in 73% in older patients. Delirium patients, have prominent risk factors for dementia, institutionalization, death, hospital care and increased cost of healthcare. The aims of this study were: 1) to determine the incidence of postoperative cardiac delirium, focusing particularly on elderly individuals; 2) to identify the predisposing and precipitating factors of delirium; 3) evaluate the morbi-mortality associated with delirium in a follow up of eighteen months. A prospective observational cohort study (n=173) patients, aged >= 60 years, admitted at Heart and Lung Messejana\'s Hospital between September/2011 to December/2013. Before the surgery, the Mini-Mental Status Examination (MMSE) and Verbal Fluency Test (VFT) were administered to assess patient\'s cognitive functioning. The patients were screened for delirium using the Confusion Assessment Method (CAM). Patients were excluded preoperatively if they met criteria for delirium. Variables related to demographic data, previous diseases, medications were recorded and EuroSCORE II calculated the risk of surgical mortality for each patient. Results of preoperative tests, like ECG, echocardiography, cardiac catheterization, carotid Doppler ultrassound and laboratory tests were also recorded. During the surgery, variables were ECC (extracorporeal circulation) and aortic clamping time, duration of surgery and anesthesia, and blood products were also recorded. Postoperative variables analyzed were: the orotracheal intubation time (OIT), length of stay in the ICU, renal dysfunction and hypoxemia. The postoperative delirium was accessed by CAM-ICU. Mortality from any cause, infection and perioperative myocardial infarction, identified until hospital discharge or 30 days after surgery were predefined as the composite endpoint. During a follow up of 12 to 18 months, a new assessment using MMSE and VFT were held; events such as, deaths, readmissions and dementia were recorded. Multivariate analysis was performed by multiple logistic regressions to identify independent variables. Patients aged 69.5 ± 5.8. About 75.14% were hypertensive; 39.88% were diabetic. The mean EuroSCORE II was 4.06±3.86. About 30.06% were illiterate; an average 3.05 ± 3.08 years of school. In 70% of cases, delirium was detected at the first two days after surgery with an incidence of 34.1%. The degree of literacy (OR = 0,81; 95% CI 0,71 - 0,92; p=0,002), hypertension (OR = 2,73; 95% CI 1,16 - 6,40; p=0,021) and mitral valve disease (OR = 2,93; 95% CI 1,32 - 6,50; p=0,008) were independently associated with delirium. Longer ICU length of stay (OR=1,18; 95% CI 1,07 - 1,30; p=0,001) was also independently associated with delirium as a precipitation factor. Delirium was an independent risk factor for the composite outcome (OR = 2.35; 95% CI 1.20 - 4.58 and p = 0.012); OIT > 900 minutes (OR = 2.50; 95% CI 1.30 - 4.80; p = 0.006) after multivariate analysis. There was no relationship between delirium and mortality after hospital discharge, as well as, dementia or hospital readmission during follow up

O presente estudo teve como objetivo identificar as evidências científicas relacionadas à retenção urinária (RU) do paciente no pós-operatório imediato. O estudo foi realizado através de Scoping Review, segundo preceitos do Instituto Joanna Briggs (JBI). A busca dos estudos foi realizada por meio da questão norteadora: quais as evidências científicas produzidas sobre o paciente em RU no pós-operatório imediato? Para a construção da pergunta de pesquisa, foi utilizada a estratégia PICO (Paciente, Intervenção, Comparação e Outcomes). Para a busca dos estudos, foram utilizadas as seguintes bases de dados: PubMed National Center for Biotechnology Information National Institutes of health; Web of Science (WOS); Centro Latino-Americano e do Caribe de Informações em Ciências (Lilacs); Base de dados de Enfermagem (BDENF); Cumulative Index to Nursing and Allied Health Literature (Cinahl); Sci Verse Scopus (Scopus); Cochrane Collaboration (Cochrane). Entre os 398 artigos encontrados, após leitura exaustiva dos títulos e resumos, 48 foram lidos na íntegra. Entre os 48 artigos analisados, oito foram incluídos nesta pesquisa. A maior parte dos artigos estudados foi escrita na língua inglesa e publicada em periódicos médicos; apenas um tratou-se de publicação na área de enfermagem, embora todos estivessem relacionados a diferentes modalidades cirúrgicas (vascular, abdominal, torácica, colorretal, ortopédica e cirurgias eletivas não determinadas). Nos estudos, foram encontradas evidências científicas relacionadas a fatores de risco para RU no pós-operatório, prevalência e incidência de RU no pós-operatório, taxas de cateterismos urinários desnecessários no pós- operatório, a possibilidade de intervenção do processo de micção do pré-operatório no pós-operatório e, ainda, a relação da RU com o uso de alguns anestésicos. Para o diagnóstico da RU no pós-operatório, o método de escolha utilizado foi o uso do ultrassom portátil de bexiga urinária e, para a resolução do problema, foi utilizado o cateterismo urinário. Conclui-se que existem evidências que relacionam a RU ao período pós-operatório imediato. Ao aplicar esse conhecimento na prática clínica, o enfermeiro pode individualizar a assistência de enfermagem a esse paciente. Todavia, são escassas as publicações da enfermagem sobre o assunto. Nesse sentido, faz-se necessário, por parte dos enfermeiros, investir nesse tema para qualificar e assegurar a assistência prestada / This study aimed to identify the scientific evidence related to urinary retention (UR) of the patient in the immediate postoperative. Study held through Scoping Review, according to Joanna Briggs Institute (JBI). The search of the studies was performed using the guiding question: What are scientific evidence produced about the patient in the UR in the immediate postoperative period? For the construction of the research question was used the PICO strategy (Patient, Intervention, Comparison and Outcomes). For the quest of the studies were used the following database: PubMed National Center for Biotechnology Information National Institutes of health; Web of Science (WOS); Latin American and Caribbean Center on Health Sciences Information (Lilacs); Base de dados de Enfermagem (BDENF); Cumulative Index to Nursing and Allied Health Literature (Cinahl); SciVerse Scopus (Scopus); Cochrane Collaboration (Cochrane). Among the 398 articles found, after exhaustive reading the titles and abstracts, 48 were read in full. Among the 48 analyzed, eight articles were included in this study. The majority of articles studied was written in English and published in medical journals and just one was treated for publication in the nursing field. These articles were related to different surgical procedures (vascular, abdominal, thoracic, colorectal, orthopedic and elective surgeries). In the selected studies, findings were related to risk factors for UR after surgery, prevalence and incidence of UR postoperative, unnecessary urinary catheterizations, rates after surgery, if the urination process preoperatively intervenes after surgery and still UR ratio using certain anesthetic. The method of choice was the portable ultrasound bladder for diagnosis of urinary retention in the immediate postoperative period. Regarding the resolution of the problem was used urinary catheterization. There are evidences relating to urinary retention in the immediate postoperative period. This knowledge in clinical practice enables nurse to apply individualized, quality and secure assistance. However are scarce nursing publications on this theme. In this sense, it is necessary by nurses will invest in this theme to qualify and ensure the assistance

Introdução: A displasia do desenvolvimento do quadril (DDQ) acomete de 1,5 a 2,5, em cada 1000 nascidos vivos. O tratamento pode variar desde o uso do suspensório até a redução cruenta, associada ou não a osteotomias da bacia e do fêmur. A avalição da redução, após as reduções incruentas ou cruentas, é feita por meio de radiografias uniplanares e complementada com imagens de tomografia ou de ressonância magnética. Uma incidência radiográfica, geralmente não usada para essa finalidade, pode ajudar nessa avaliação: a radiografia Inlet. Este estudo tem como objetivo avaliar a eficácia da radiografia Inlet, em comparação com a tomografia, método utilizado atualmente em nosso serviço para essa avaliação. Secundariamente, busca avaliar a reprodutibilidade da avaliação, através de correlações intra e inter observadores. Métodos: Foram avaliados pacientes com diagnóstico de DDQ, operados entre 2013 e 2015. Todos os pacientes foram submetidos à incidência radiográfica Inlet pós-operatória e a tomografia. Foram realizadas avaliações cegas, em imagens distribuídas randomicamente intra e entre avaliadores, correlacionadas pelo índice Kappa (IC 95%). Foi também realizado um consenso entre os avaliadores que foi comparado com os resultados da tomografia. Essa correlação foi avaliada pelo índice Kappa ponderado (IC 95%) e assim foram obtidas as medidas diagnósticas: sensibilidade, especificidade, valor preditivo positivo (VPP), valor preditivo negativo (VPN), likelihood positivo (LR+) e likelihood negativo (LR). Resultados: Foram obtidas 25 radiografias de um total de 22 pacientes, que foram incluídas neste estudo. A idade média de tratamento foi de 2,95 anos e variou entre um e cinco anos, com maior prevalência no sexo feminino e maior incidência no lado esquerdo. As avaliações intra e inter-observadores tiveram valores semelhantes e com índice Kappa alto, 0,834 (IC 95%). A correlação entre o consenso e a tomografia mostrou alta concordância Kappa = 0,834 (IC95%), com 100% de sensibilidade, especificidade de 95,5% e valor preditivo negativo de 100 (83,9-100). Conclusão: A incidência radiográfica Inlet se mostrou um método viável e confiável, em comparação com a tomografia computadorizada para a avaliação pós-operatória da redução, na displasia do desenvolvimento do quadril / Introduction: Development dysplasia of the Hip (DDH) affects 1.5 to 2.5 per 1000 live births. The treatment varies according to the age and can range from the use of the suspensory to open reduction associated with pelvic osteotomies and, or femur osteotomies. The evaluation of the reduction after the surgeries is done by means of uniplanar radiographs and complemented with tomography or magnetic resonance images. A complementary radiograph not used for this purpose may help in this evaluation: Inlet radiography. This study aims to evaluate the effectiveness of the Inlet radiography in comparison to the Tomography method currently used in our service for this evaluation. Secondarily, it seeks to evaluate the reproducibility of the evaluation through intra and inter-observer correlations. Methods: Patients with a diagnosis of DDQ operated between 2013 and 2015 were evaluated. All patients underwent postoperative inlet radiography and tomography. Blind evaluations were performed on images randomly distributed intra and between evaluators correlated by Kappa index (95% CI). A consensus was also reached among the evaluators and this was compared with the results of tomography as a gold method. This correlation was evaluated by the weighted Kappa index (95% CI) and the diagnostic measures, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood (LR +) and negative likelihood (LR) were obtained. Results: A total of 25 radiographs obtained from 22 patients were included in the study. The mean age of treatment was 2.95 years and ranged from one to five years, with a higher prevalence in females and a higher incidence on the left side. Intra and interobserver evaluations obtained similar values and high Kappa = 0.834 (95% CI). The correlation between consensus and tomography showed high Kappa agreement = 0.834 (95% CI), with 100% sensitivity, 95.5% specificity and negative predictive value of 100 (83.9-100). Conclusion: Inlet radiography proved to be a viable and reliable method compared with CT for postoperative evaluation of hip reduction in Developmental Hip Dysplasia

Sleep disruption has been implicated in morbidity after major surgery since 1974. Sleep-related upper airway obstruction has been associated with death after upper airway surgery and profound episodic hypoxaemia in the early postoperative period. There is also evidence for a rebound in rapid eye movement (REM) sleep that might be contributing to an increase in episodic sleep-related hypoxaemic events later in the first postoperative week. Speculation regarding the role of REM sleep rebound in the generation of late postoperative morbidity and mortality has evolved into dogma without any direct evidence to support it. The research presented in this thesis involved two main areas: a search for evidence of a clinically important contribution of REM sleep rebound to postoperative morbidity, and a re-examination of the role of sleep in the causation of postoperative episodic hypoxaemic events. To assess the latter, a relationship between airway obstruction under anaesthesia and the severity of sleep-disordered breathing was sought. In 148 consecutive sleep clinic patients, 49% of those with sleep-disordered breathing (SDB) had a number of events in non-rapid eye movement sleep (NREM) that was greater than or equal to that in REM and 51% had saturation nadirs in NREM that were equal to or worse than their nadirs in REM. This suggests SDB is not a REM-predominant phenomenon for most patients. Of 1338 postoperative deaths occurring over 6.5 years in one hospital only 37 were unexpected, most of which were one or two days after surgery with no circadian variation in the time of death, casting further doubt on the potential role of REM rebound. Five of nine subjects studied preoperatively had moderately severe SDB. Unrecognised and significant SDB is common in middle-aged and elderly patients presenting for surgery suggesting overall perioperative risk of important adverse events from SDB is probably small. In 17 postoperative patients, sleep macro-architecture was variably altered with decreases in REM and slow wave sleep while stage 1 sleep and a state of pre-sleep onset drowsiness, both associated with marked ventilatory instability, were increased. Sleep micro-architecture was also changed with an increase in power in the alpha-beta electroencephalogram range. These micro-architectural changes result in ambiguity in the staging of postoperative sleep that may have affected the findings of this and other studies. Twenty-four subjects with airway management difficulty under anaesthesia were all found to have some degree of SDB. Those with the most obstruction-prone airways while anaesthetised had a very high incidence of severe SDB. Such patients warrant referral to a sleep clinic.

Sleep disruption has been implicated in morbidity after major surgery since 1974. Sleep-related upper airway obstruction has been associated with death after upper airway surgery and profound episodic hypoxaemia in the early postoperative period. There is also evidence for a rebound in rapid eye movement (REM) sleep that might be contributing to an increase in episodic sleep-related hypoxaemic events later in the first postoperative week. Speculation regarding the role of REM sleep rebound in the generation of late postoperative morbidity and mortality has evolved into dogma without any direct evidence to support it. The research presented in this thesis involved two main areas: a search for evidence of a clinically important contribution of REM sleep rebound to postoperative morbidity, and a re-examination of the role of sleep in the causation of postoperative episodic hypoxaemic events. To assess the latter, a relationship between airway obstruction under anaesthesia and the severity of sleep-disordered breathing was sought. In 148 consecutive sleep clinic patients, 49% of those with sleep-disordered breathing (SDB) had a number of events in non-rapid eye movement sleep (NREM) that was greater than or equal to that in REM and 51% had saturation nadirs in NREM that were equal to or worse than their nadirs in REM. This suggests SDB is not a REM-predominant phenomenon for most patients. Of 1338 postoperative deaths occurring over 6.5 years in one hospital only 37 were unexpected, most of which were one or two days after surgery with no circadian variation in the time of death, casting further doubt on the potential role of REM rebound. Five of nine subjects studied preoperatively had moderately severe SDB. Unrecognised and significant SDB is common in middle-aged and elderly patients presenting for surgery suggesting overall perioperative risk of important adverse events from SDB is probably small. In 17 postoperative patients, sleep macro-architecture was variably altered with decreases in REM and slow wave sleep while stage 1 sleep and a state of pre-sleep onset drowsiness, both associated with marked ventilatory instability, were increased. Sleep micro-architecture was also changed with an increase in power in the alpha-beta electroencephalogram range. These micro-architectural changes result in ambiguity in the staging of postoperative sleep that may have affected the findings of this and other studies. Twenty-four subjects with airway management difficulty under anaesthesia were all found to have some degree of SDB. Those with the most obstruction-prone airways while anaesthetised had a very high incidence of severe SDB. Such patients warrant referral to a sleep clinic.

Lic.-avh. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 2 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 4 uppsatser.