SpO2 - how low for how long?

[halcion]

I have been doing anaesthetic nursing for a few months and this is only my second year nursing, so pretty green on all fronts and don't know when I'm overreacting. I remember freaking out at sats of 94% not that long ago

So tonight I had a patient with good sats pre op but obesity. The anaesthetist used a "Supreme" LMA and a couple of minutes later the sats were low 90s. Another couple of minutes and they were high 80s. After some pointed looks from me he checked the airway, the connections, the sats probe etc. Surgery hasn't started yet but is about to and he lets them commence. Sats are now mid-80s, patient is starting to cyanose. The anaesthetist tells me it's because he gave 20 of morph (but the patient has an airway and is being bagged and the BP is fine??). He's hand ventilating the patient and seems pretty attentive but completely unconcerned. I get my team leader, by the time she's arrived sats are 73% and she relieves me.

I go back in later to speak to my team leader about something else and the sats are still low 80s (it's been over an hour now) and everyone seems completely unconcerned and say that they think he probably has sleep apnoea so will be going to HDU overnight. I wonder if I am completely insane, sleep apnoea with an LMA?? And am I overreacting about sats hovering around 80 for a couple of hours?

So my question is SpO2 - how low for how long is unacceptable?

[drums326]

Yeah, your nursing instincts are spot on, that is whack!

[Mr. & Mrs. RN]

He should have done some labs, check the SaO2 (blood gases), see what's going on with this guy. I don't think I've seen an anesthesiologist let a patient sit at that number for more than a few minutes.

[halcion]

More than a few minutes? Far out.

As I said I haven't been a nurse for long, but I did my first year at the state's number one trauma centre and saw a little and worked in PACU. In that year under NO circumstances did I see sats that low without bells and whistles. Literally, with the exception of laryngospasm in that time I never saw a patient get that low. Extra measures were put in place WAY before 73%. But those measures were jaw support, suction, non-rebreather, bagging, and.. call a doctor...

Funding was cut, nurses lost jobs, and I was lucky to find a Recovery job in a provincial private hospital. And I don't know if it's just the new experience of working in OR, the extra experience I'm exposed to by working only with consultants, or that they're less up to date, but things have definitely changed.

There is one anaesthetist who doesn't pre-oxygenate patients prior to intubation. So say you start with sats of 96%, by the time you have propofol and relaxants on board you've got a patient in the mid 80s when he STARTS attempts to intubate. If it's a difficult intubation then you're in the 60's or 70's by the time the ET is in place. At first I was terrified - the only time I've seen a person that color actually recover is from laryngospasm (which was treated by eager RMOs) but at this private hospital there's this culture of obsequiousness to doctors and no says a word and even if I do I am not sure that in going to senior staff members anything is achieved.