In this section
IntroductionAimDefinition of TermsPre-Operative Assessment
Minimising Risk Intraoperatively
Overnight admission and monitoring
Management of an Apnoea
Family Centred Care
Cessation of Apnoea Monitoring
Apnoeas in infants following anaesthesia and sedation can be potentially life threatening. The aetiology of postoperative apnoea may involve a complex interplay of residual anaesthetic suppression of an immature central respiratory drive, stress from the surgery, airway obstruction, poor respiratory reserve or infection and sepsis. Infants are most at risk of having an apnoea during the first 2 hours of the post-operative period; however, apnoeas can occur within 12 hours following surgery. Regional anaesthesia has shown to decrease the risk of apnoea in the early postoperative period (<30 minutes), however in late postoperative apnoea (30 minutes – 12 hours) there regional anaesthesia has same risk as general anaesthesia. An apnoea could be central, obstructive or mixed. Apnoea monitoring should begin immediately in the Post Anaesthetic Care Unit and continue until the patient has had 12 hours of apnoea-free monitoring.
This guideline was created to have a clear understanding of the specific patients that require admission for apnoea monitoring post operatively and to standardise the care these patients receive. The aim is to define the age that patients require apnoea monitoring as well as the causes of post-operative apnoea and how to minimise risk. It also outlines the nursing roles and responsibilities when caring for these patients including the acute management of an apnoea.
Nursing staff should be aware on admission of the patients that require post-operative apnoea monitoring based on their gestational and postmenstrual age (please refer to table). This can help ensure that an overnight bed has been arranged for the patient and that they have not been incorrectly booked as a day case. Nursing staff should take a detailed history including comorbidities (e.g chronic lung disease), degree of prematurity, duration and degree of respiratory support, history of apnoeas, need for caffeine or oxygen therapy. Nursing staff should assess the patient pre-operatively for any signs of respiratory distress.
Risk factors for apnoeas post-operatively may be related to:
The Anaesthetist in consultation with Surgeons must determine the need for overnight admission for post-operative apnoea monitoring based on the patients gestational age and postmenstrual age on the day of surgery and any other existing risk factors they feel may increase the risk of an apnoea.
preterm infants who have reached a PMA of 60 weeks can be sent home on standard
if the Anaesthetist and Surgeon agree.
term infants between 46-60 weeks PMA there is currently no consensus as to
whether or not these infants need overnight apnoea monitoring. At RCH it is at
the discretion of the Anaesthetist, in discussion with the Surgeon whether an
infant of 46-60 weeks PMA warrants admission or an extended stay for
post-operative apnoea monitoring.
extended period of stay allows the patient to receive post-operative apnoea
monitoring in Day of Surgery for a shorter period than 12 hours. This enables
the patient to have several sleep wake cycles while receiving apnoea
monitoring. The Anaesthetist will then review the patient later in the day and
determine to send the patient home if there have been no clinically significant
apnoeas or other issues.
infant who has had a clinically significant apnoea in the postoperative period
should be admitted for overnight apnoea monitoring.
monitoring should commence immediately in the Post Anaesthetic Care Unit (PACU)
and continue once the patient arrives to the ward.
Monitoring should include:
the event of a monitor alarming the nurse should:
apnoeic episodes will resolve spontaneously or with minor stimulation. All
episodes should be documented and reported to medical staff.
a patient is having frequent significant apnoeas the medical team should be notified. The patient may require respiratory support or mechanical ventilation such as HFNP or CPAP and potentially require transfer to a HDU bed.
or pausing alarms:
monitoring should continue until the patient has had 12 apnoea-free hours.
Please see attachment.
Please remember to read the disclaimer.
The development of this nursing guideline was coordinated by Ebony Larter, CNS, Possum and approved by the Nursing Clinical Effectiveness Committee. First published March 2020.