Perioperative oxygen administration: finding the sweet spot

• Published in: BMJ (Online) Vol. 379; p. o2897
• Main Authors: McIlroy, David R, Billings, Frederic T
• Format: Journal Article
• Language: English
• Published: London British Medical Journal Publishing Group 30.11.2022; BMJ Publishing Group LTD
• Subjects: Anesthesia; Atelectasis; Clinical trials; Hyperoxia; Opinion; Oxygen; Oxygen therapy; Oxygenation; Perioperative care; Surgical site infections; Titration; Toxicity; Vomiting
• ISSN: 1756-1833; 1756-1833
• DOI: 10.1136/bmj.o2897

Oxygen administration over the years can be summarised as a “Goldilocks phenomenon.” The risk of inadequate patient oxygenation was recognised in the earliest days of anaesthesia, leading to the routine administration of supplemental oxygen during surgery, often far exceeding that required to avoid hypoxaemia. In the 1980s, continuous pulse oximetry made the practice of down-titration of oxygen administration possible while maintaining a level of oxyhaemoglobin thought to be safe. Clinical textbooks on anaesthesia at the time spoke of oxygen toxicity only in terms of atelectasis and subjective chest discomfort, meaning that intraoperative hyperoxygenation persisted. By the early 2000s, clinical trials reported potentially important benefits from high levels of perioperative oxygen administration for important outcomes such as postoperative nausea, vomiting, and surgical site infection.1234 At the same time, however, laboratory studies increasingly reported harmful cellular effects of excess oxygen exposure, and earlier clinical trial results favouring high levels of perioperative oxygen administration could not be reliably replicated. With newfound equipoise, multiple clinical trials of hyperoxia avoidance were initiated in critically ill cohorts.5678910 The operating room, however, has remained relatively unexplored by research testing the effects of hyperoxia avoidance strategies.