P OSTOPERATIVE pulmonary complications are common and affect morbidity and mortality in patients undergoing major surgery. 1 Intraoperative ventilation strategies for lung protection include low tidal volume, positive end-expiratory pressure (PEEP), and recruitment maneuvers. These strategies appear to improve clinical outcomes in patients undergoing major abdominal surgery. 2 However, the strategies do not consider supplemental oxygen, which is an essential component of ventilator management. Supplemental oxygen administration during mechanical ventilation is important for preventing or correcting hypoxemia, both in the intensive care unit and in the operation theater. Several observational studies of intensive care unit patients receiving mechanical ventilation found that conventional oxygen therapy was liberally administered, and this could potentially induce hyperoxemia, 3-6 which is a potentially injurious condition. High oxygen levels can enhance reactive oxygen species formation and oxidative stress, induce peripheral vasoconstriction, and decrease cardiac output. 7,8 Moreover, adverse clinical outcomes What We Already Know about This Topic • Despite the potentially harmful effects of oxygen overexposure, supplemental oxygen therapy is commonly prescribed in several clinical conditions. However, little is known about current oxygen administration practices during general anesthesia. What This Article Tells Us That Is New • In this multicenter, cross-sectional study of 1,498 patients at 43 hospitals, potentially preventable hyperoxemia and substantial oxygen exposure were common during general anesthesia, especially in patients receiving one-lung ventilation.

ACs after LDLLT, limited to bronchial stenosis, require significantly earlier treatment and have a greater adverse impact on survival than ACs after CLT.

on behalf of the MAMACARI Investigators Background: The aim of this study was to evaluate the efficacy and safety of transdermal β-blocker patches, which offer stable blood concentration and easy availability during operation, for prevention of perioperative myocardial injury (PMI) in high-risk patients. Methods and Results: In this randomized controlled trial, patients aged >60 years with hypertension and high revised cardiac risk index (≥2) undergoing non-cardiac surgery were randomly assigned to a bisoprolol patch or control group. Primary efficacy outcome was incidence of PMI, defined as postoperative high-sensitivity cardiac troponin T (hs-cTnT) >0.014ng/mL and relative hs-cTnT change ≥20%. Secondary efficacy outcomes were number of cardiovascular events and 30-day mortality. From November 2014 to February 2019, 240 patients from 5 hospitals were enrolled in this study. The incidence of PMI was 35.7% in the bisoprolol patch group and 44.5% in the control group (P=0.18). Incidence of major adverse cardiac events including non-critical myocardial infarction, strokes, decompensated heart failure and tachyarrhythmia was similar between the 2 groups. Tachyarrhythmia tended to be higher in the control group. There were no significant differences in safety outcomes including significant hypotension and bradycardia requiring any treatment between the 2 groups. Conclusions: Bisoprolol patches do not influence the incidence of PMI and cardiovascular events in high-risk patients undergoing non-cardiac surgery, but perioperative use of these patches is safe.

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