Perioperative Oxidative Stress and Sepsis: Pathophysiological and Clinical Implications

The relationship between oxidative stress and sepsis determines how well patients recover from surgery and critical illness. The perioperative period creates conditions for excessive reactive oxygen species (ROS) and reactive nitrogen species (RNS) production through surgical trauma and anesthesia and tissue hypoperfusion and infection, leading to mitochondrial damage, endothelial harm, and immune system problems. The processes create more inflammation while damaging cellular energy systems, which results in multiple organ system failure. The review examines modern knowledge about perioperative oxidative stress and sepsis mechanisms while discussing treatment implications and new therapeutic approaches. The authors conducted database searches in PubMed, Web of Science, and Scopus to find English-language peer-reviewed studies about oxidative stress and perioperative sepsis. The authors used the keywords "oxidative stress", "perioperative", and "sepsis" to find relevant studies from 2000 to 2025. The most effective strategy to reduce oxidative damage and enhance patient results involves early infection control, normoxia preservation, and accurate fluid management during perioperative care. The current understanding of oxidative stress has not led to the successful clinical implementation of targeted antioxidant treatments. Research should concentrate on developing individualized antioxidant treatments based on biomarker tests while conducting clinical trials to assess mitochondrial protective effects. The integration of mechanistic knowledge with clinical practice makes oxidative stress modulation a fundamental approach to enhance survival rates of patients with sepsis and those undergoing high-risk surgery.