Reader response
Myron Yaster MD
From Andreas H. Taenzer, MD, MS, Professor of Anesthesiology and Critical Care Medicine & Pediatrics, The George Washington University School of Medicine and Health Sciences, Professor at The Dartmouth Institute for Health Policy & Clinical Practice, The Theodor Geisel School of Medicine at Dartmouth
The PAAD recently discussed the issue of monitoring of postoperative patients and Myron raised the common concern regarding patients on supplemental oxygen and their risk of rapid desaturation, putting them at risk of adverse respiratory events with insufficient time for intervention. This is a common concern. If modeled in a virtual environment with complete apnea indeed the quicker desaturation of patients on oxygen holds true.
In a publication in March 2018 of A&A “Characteristics of Desaturation and Respiratory Rate in Postoperative Patients Breathing Room Air Versus Supplemental Oxygen: Are They Different?” we attempted to address concern. In postoperative adult patients monitored with pulse oximetry and a sound based respiratory sensor we investigated the following two questions comparing patients on oxygen (O2) and room air (RA): (1) Do Desaturation features such as speed, magnitude or duration differ, and (2) how does RR behave in these events?
We found that desaturation characteristics did not differ between patients receiving O2 and breathing RA in regards to speed, depth, or duration of desaturation. Transition time for desaturations to reach low oxygen saturation alarms was not different, while respiratory rate remained in the normal range during these events. This is likely due to the fact that with changed strategies on how we are using opioids (smaller, more frequent doses) and actual respiratory arrests or very low respiratory rates is extremely rare vs the more common scenario of hypoventilation and atelectasis.
Taenzer, Andreas H., et al. "Characteristics of desaturation and respiratory rate in postoperative patients breathing room air versus supplemental oxygen: are they different?." Anesthesia & Analgesia 126.3 (2018): 826-832.
From Brian Huang, DDS JD
A maxillary block also can be achieved going through the greater palatine canal. It’s a little safer and easier to achieve than going through the suprazygomatic arch.