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Biomedical subjects
T Ullstad
Publications and source records attributed to T Ullstad.
Late postoperative episodic and constant hypoxaemia and associated ECG abnormalities.
Twenty-two patients without cardiopulmonary disease and undergoing elective major abdominal surgery were monitored continuously with a Holter tape recorder and a pulse oximeter on one night before operation and the first two nights after operation (23:00 to 07:00), without oxygen therapy. Mean heart rate increased 16 beat min-1 (P less than 0.001) and mean oxygen saturation (SaO2) decreased 2.6% (P less than 0.001) after operation. Episodic oxygen desaturation to less than 80% occurred in four patients before operation, but in 13 patients after operation (P less than 0.05). ECG abnormalities were observed in 10 patients before operation and in 16 patients after operation (ns). Individual maximum ST depression was more pronounced after than before operation (P less than 0.05). Episodic desaturation was related closely to tachycardia in six patients before operation and one patient after operation; before operation to atrioventricular block in one patient, and after operation to ST depression in two patients. Mean SaO2 on the second night after operation correlated with total dose of opioid for pain relief (rs = -0.48; P less than 0.05), and postoperative decrease in SaO2 correlated with postoperative increase in heart rate (rs = -0.43; P less than 0.05). No patient had postoperative cardiac complications indicating treatment.
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Continuous assessment of oxygen saturation and subcutaneous oxygen tension after abdominal operations.
Ten patients undergoing abdominal operations had oxygen saturation (SpO2) and transcutaneous (PtcO2) and subcutaneous (PscO2) oxygen tensions monitored continuously during the second and third postoperative nights from 11 pm to 7 am. At the end of the second postoperative night an oxygen stimulation test (10 l/min by face mask) was carried out in eight of the 10. Median SpO2 was 91% (range 82-95) on the second, and 91% (86-95) on the third, postoperative nights, respectively. Six patients had intermittent episodes of desaturation to less than 80%, each of less than one minute's duration. PtcO2, but not PscO2, followed the episodic variations in SpO2. PscO2 was 58 mmHg (46-69) on the second postoperative night and 61 mmHg (48-71) on the third postoperative night. PscO2 correlated with SpO2 in all but one patient who had lower PscO2 than expected from the measured SpO2 and estimated PaO2. Oxygen treatment increased individual PscO2 by 14 mmHg (9-49), PtcO2 by 38 mmHg (10-104), and SpO2 to 99% (95-100), but stable PscO2 was not achieved within the 20 minute period of treatment. These results obtained during continuous measurements show pronounced intersubject differences in oxygen tensions near the surgical wound in the late postoperative period. The results suggest that pulmonary oxygenation is the most important determinant of mean subcutaneous oxygen tension after uncomplicated elective abdominal operations.
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