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Effects of perioperative oxygen concentration on oxidative stress in adult surgical patients: a systematic review

Effects of perioperative oxygen concentration on oxidative stress in adult surgical patients: a systematic review
Effects of perioperative oxygen concentration on oxidative stress in adult surgical patients: a systematic review
Background: the fraction of inspired oxygen (FIO2) administered during general anaesthesia varies widely despite in-ternational recommendations to administer FIO20.8 to all anaesthetised patients to reduce surgical site infections (SSIs).Anaesthetists remain concerned that high FIO2administration intraoperatively may increase harm, possibly throughincreased oxidative damage. In previous systematic reviews associations between FIO2and SSIs have been inconsistent,but none have examined how FIO2affects perioperative oxidative stress. We aimed to address this uncertainty byreviewing the available literature.

Methods: EMBASE, MEDLINE, and Cochrane databases were searched from inception to March 9, 2020 for RCTscomparing higher with lower perioperative FIO2and quantifying oxidative stress in adults undergoing noncardiac sur-gery. Candidate studies were independently screened by two reviewers and references hand-searched. Methodologicalquality was assessed using the Cochrane Collaboration Risk of Bias tool.

Results:from 19 438 initial results, seven trials (n¼422) were included. Four studies reported markers of oxidative stressduring Caesarean section (n¼328) and three reported oxidative stress during elective colon surgery (n¼94). Risk of biaswas low (four studies) to moderate (three studies). Pooled results suggested high FIO2was associated with greatermalondialdehyde, protein-carbonyl concentrations and reduced xanthine oxidase concentrations, together with reducedantioxidant markers such as superoxide dismutase and total sulfhydryl levels although total antioxidant status wasunchanged.

Conclusions: higher FIO2may be associated with elevated oxidative stress during surgery. However, limited studies havespecifically reported biomarkers of oxidation. Given the current clinical controversy concerning perioperative oxygentherapy, further research is urgently needed in this area.
0007-0912
Oldman, Alex
92781b91-5e50-4809-a71a-f7871ee29169
Martin, Daniel Stuart
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Feelisch, Martin
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Grocott, Michael
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Cumpstey, Andrew F
050a389c-f550-4453-a80a-f1a6e57db923
Oldman, Alex
92781b91-5e50-4809-a71a-f7871ee29169
Martin, Daniel Stuart
60c161c9-bc3e-4649-831a-9361c88cd14f
Feelisch, Martin
8c1b9965-8614-4e85-b2c6-458a2e17eafd
Grocott, Michael
1e87b741-513e-4a22-be13-0f7bb344e8c2
Cumpstey, Andrew F
050a389c-f550-4453-a80a-f1a6e57db923

Oldman, Alex, Martin, Daniel Stuart, Feelisch, Martin, Grocott, Michael and Cumpstey, Andrew F (2020) Effects of perioperative oxygen concentration on oxidative stress in adult surgical patients: a systematic review. British Journal of Anaesthesia. (doi:10.1016/j.bja.2020.09.050).

Record type: Review

Abstract

Background: the fraction of inspired oxygen (FIO2) administered during general anaesthesia varies widely despite in-ternational recommendations to administer FIO20.8 to all anaesthetised patients to reduce surgical site infections (SSIs).Anaesthetists remain concerned that high FIO2administration intraoperatively may increase harm, possibly throughincreased oxidative damage. In previous systematic reviews associations between FIO2and SSIs have been inconsistent,but none have examined how FIO2affects perioperative oxidative stress. We aimed to address this uncertainty byreviewing the available literature.

Methods: EMBASE, MEDLINE, and Cochrane databases were searched from inception to March 9, 2020 for RCTscomparing higher with lower perioperative FIO2and quantifying oxidative stress in adults undergoing noncardiac sur-gery. Candidate studies were independently screened by two reviewers and references hand-searched. Methodologicalquality was assessed using the Cochrane Collaboration Risk of Bias tool.

Results:from 19 438 initial results, seven trials (n¼422) were included. Four studies reported markers of oxidative stressduring Caesarean section (n¼328) and three reported oxidative stress during elective colon surgery (n¼94). Risk of biaswas low (four studies) to moderate (three studies). Pooled results suggested high FIO2was associated with greatermalondialdehyde, protein-carbonyl concentrations and reduced xanthine oxidase concentrations, together with reducedantioxidant markers such as superoxide dismutase and total sulfhydryl levels although total antioxidant status wasunchanged.

Conclusions: higher FIO2may be associated with elevated oxidative stress during surgery. However, limited studies havespecifically reported biomarkers of oxidation. Given the current clinical controversy concerning perioperative oxygentherapy, further research is urgently needed in this area.

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Accepted/In Press date: 5 September 2020
e-pub ahead of print date: 24 November 2020

Identifiers

Local EPrints ID: 445170
URI: http://eprints.soton.ac.uk/id/eprint/445170
ISSN: 0007-0912
PURE UUID: 1730e19e-b0a5-4d11-ad29-1209f2b97529
ORCID for Martin Feelisch: ORCID iD orcid.org/0000-0003-2320-1158
ORCID for Michael Grocott: ORCID iD orcid.org/0000-0002-9484-7581
ORCID for Andrew F Cumpstey: ORCID iD orcid.org/0000-0001-6257-207X

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Date deposited: 24 Nov 2020 17:32
Last modified: 26 Nov 2021 03:20

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Contributors

Author: Alex Oldman
Author: Daniel Stuart Martin
Author: Martin Feelisch ORCID iD
Author: Michael Grocott ORCID iD
Author: Andrew F Cumpstey ORCID iD

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