Perioperative Oxidative Stress and Sepsis: Pathophysiological and Clinical Implications

Area of Science:

• Critical Care Medicine
• Biochemistry
• Surgical Science

Background:

• Perioperative oxidative stress, characterized by excessive reactive oxygen species (ROS) and reactive nitrogen species (RNS) production, is a critical factor in surgical and critical illness recovery.
• This stress, induced by surgical trauma, anesthesia, hypoperfusion, and infection, leads to mitochondrial damage, endothelial dysfunction, and immune dysregulation, promoting inflammation and organ system failure.

Purpose of the Study:

• To review current knowledge on perioperative oxidative stress and sepsis mechanisms.
• To discuss treatment implications and novel therapeutic strategies for managing oxidative stress in perioperative sepsis.

Main Methods:

• A comprehensive literature search was conducted in PubMed, Web of Science, and Scopus.
• English-language peer-reviewed studies published between 2000 and 2025 were included, using keywords: "oxidative stress", "perioperative", and "sepsis".

Main Results:

• Effective strategies to mitigate oxidative damage include early infection control, maintaining normoxia, and precise fluid management.
• Despite understanding oxidative stress mechanisms, targeted antioxidant treatments have not yet translated successfully into clinical practice.

Conclusions:

• Further research should focus on developing individualized antioxidant treatments guided by biomarker testing and assessing mitochondrial protective effects through clinical trials.
• Integrating mechanistic insights with clinical practice is essential for modulating oxidative stress to improve survival rates in sepsis and high-risk surgical patients.