Perioperative oxygenation-what's the stress?

Area of Science:

• Anesthesiology
• Critical Care Medicine
• Surgical Safety

Background:

• Oxygen is the most frequently administered drug in anesthesia.
• Optimal perioperative oxygen levels are debated due to risks of both hyperoxia and hypoxia.
• Current guidelines, like the WHO's recommendation of 0.8 FiO2, conflict with some research suggesting potential harm.

Purpose of the Study:

• To review current evidence on perioperative oxygen administration.
• To contrast oxygen use in anesthesia with other specialties.
• To explore the impact of oxygen on surgical stress response and patient outcomes.

Main Methods:

• Narrative review based on the BJA William Mapleson lecture.
• Analysis of existing clinical trial data and Cochrane reviews.
• Comparison of anesthetic oxygen practices with intensive care medicine.

Main Results:

• Conflicting evidence exists regarding the optimal fractional inspired oxygen concentration (FiO2).
• Concerns remain about potential increased morbidity and mortality with high FiO2, particularly in certain patient groups.
• The WHO's recommendation for high FiO2 is debated, with some study results deemed 'biologically implausible'.

Conclusions:

• Resolving controversies in perioperative oxygen administration is crucial for clinicians.
• Individualized oxygenation strategies are needed, requiring novel clinical trial designs.
• Further research is necessary to optimize patient oxygenation during the perioperative period.