Perioperative oxygenation-what's the stress?

Autor: Larvin J; Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK.; Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK., Edwards M; Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK.; Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK., Martin DS; Peninsula Medical School, University of Plymouth, Plymouth, UK., Feelisch M; Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK.; Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK., Grocott MPW; Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK.; Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK., Cumpstey AF; Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK.; Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
Jazyk: angličtina
Zdroj: BJA open [BJA Open] 2024 Mar 20; Vol. 10, pp. 100277. Date of Electronic Publication: 2024 Mar 20 (Print Publication: 2024).
DOI: 10.1016/j.bjao.2024.100277
Abstrakt: Oxygen is the most used drug in anaesthesia. Despite such widespread use, optimal perioperative oxygen administration remains highly controversial because of concerns about the competing harms of both hyperoxia and hypoxia. Notwithstanding a Cochrane review concluding that routinely administering a fractional inspired oxygen concentration (FiO 2 ) >0.6 intraoperatively might increase postoperative morbidity and mortality, the World Health Organization (WHO) currently recommends all anaesthetised patients receive 0.8 FiO 2 during and immediately after surgery to reduce surgical site infections. Results from the largest trial available at the time of these two reviews (suggesting long-term survival may be worse with high FiO 2 , particularly in patients with malignant disease) were considered 'biologically implausible' by the WHO's Guideline Development Group. In addition, the integrity of some perioperative oxygen studies has been challenged. Resolving these controversies is of fundamental importance to all perioperative clinicians. This narrative review is based on the inaugural BJA William Mapleson lecture delivered by the senior author (AC) at the 2023 annual meeting of the Royal College of Anaesthetists in Birmingham. We present the current evidence for perioperative oxygen administration and contrast this with how oxygen therapy is targeted in other specialties (e.g. intensive care medicine). We will explore whether anaesthetists follow the WHO recommendations and consider how oxygen administration affects the stress response to surgery. We reason that novel clinical trial designs in combination with targeted experimental medicine studies will be required to improve our understanding of how best to optimise individualised perioperative oxygenation-a cornerstone of anaesthesia.
(© 2024 The Authors.)
Databáze: MEDLINE
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