Association between perioperative hyperoxia and cerebrovascular complications after laparotomy—A post‐hoc follow‐up study

Kongebro, Emilie Katrine; Jørgensen, Lars N.; Siersma, Volkert; Meyhoff, Christian S.

doi:10.1111/aas.13235

Cited by 10 publications

(9 citation statements)

References 32 publications

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“…Hyperoxia increases ROS levels that inactivate NO thereby resulting in systemic, coronary, and cerebral vasoconstriction. 23,24 This effect is very crucial during the reperfusion period in patients with AIS treated by endovascular thrombectomy to avoid excess production of ROS. Of note, 100% inspiratory oxygen results in reducing mean cerebral blood flow by 27% in young healthy adults and 16% mean reduction in an older subgroup in interventional magnetic resonance imaging study.…”

Section: Discussionmentioning

confidence: 99%

Oxygen Saturation and Postoperative Mortality in Patients With Acute Ischemic Stroke Treated by Endovascular Thrombectomy

Farag

Liang

Mascha

et al. 2021

Anesthesia &Amp; Analgesia

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BACKGROUND: Monitored anesthesia care (MAC) and general anesthesia (GA) with endotracheal intubation are the 2 most used techniques for patients with acute ischemic stroke (AIS) undergoing endovascular thrombectomy. We aimed to test the hypothesis that increased arterial oxygen concentration during reperfusion period is a mechanism underlying the association between use of GA (versus MAC) and increased risk of in-hospital mortality. METHODS: In this retrospective cohort study, data were collected at the Cleveland Clinic between 2013 and 2018. To assess the potential mediation effect of time-weighted average oxygen saturation (Spo 2 ) in first postoperative 48 hours between the association between GA versus MAC and in-hospital mortality, we assessed the association between anesthesia type and post-operative Spo 2 tertiles (exposure-mediator relationship) through a cumulative logistic regression model and assessed the association between Spo 2 and in-hospital mortality (mediator-outcome relationship) using logistic regression models. Confounding factors were adjusted for using propensity score methods. Both significant exposure-mediator and significant mediator-outcome relationships are needed to suggest potential mediation effect. RESULTS: Among 358 patients included in the study, 104 (29%) patients received GA and 254 (71%) received MAC, with respective hospital mortality rate of 19% and 5% (unadjusted P value <.001). GA patients were 1.6 (1.2, 2.1) (P < .001) times more likely to have a higher Spo 2 tertile as compared to MAC patients. Patients with higher Spo 2 tertile had 3.8 (2.1, 6.9) times higher odds of mortality than patients with middle Spo 2 tertile, while patients in the lower Spo 2 tertile did not have significant higher odds compared to the middle tertile odds ratio (OR) (1.8 [0.9, 3.4]; overall P < .001). The significant exposure-mediator and mediator-outcome relationships suggest that Spo 2 may be a mediator of the relationship between anesthetic method and mortality. However, the estimated direct effect of GA versus MAC on mortality (ie, after adjusting for Spo 2 ; OR [95% confidence interval {CI}] of 2.1 [0.9-4.9]) was close to the estimated association ignoring Spo 2 (OR [95% CI] of 2.2 [1.0-5.1]), neither statistically significant, suggesting that Spo 2 had at most a modest mediator role. CONCLUSIONS: GA was associated with a higher Spo 2 compared to MAC among those treated by endovascular thrombectomy for AIS. Spo 2 values that were higher than the middle tertile were associated with higher odds of mortality. However, GA was not significantly associated with higher odds of death. Spo 2 at most constituted a modest mediator role in explaining the relationship between GA versus MAC and mortality.

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Section: Discussionmentioning

confidence: 99%

Oxygen Saturation and Postoperative Mortality in Patients With Acute Ischemic Stroke Treated by Endovascular Thrombectomy

Farag

Liang

Mascha

et al. 2021

Anesthesia &Amp; Analgesia

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“…However, when regarding cardiovascular AE, a meta-analysis of three studies showed no signal of increased ratios of these AE in patients receiving high FiO 2 [12]. Data on the incidence of stroke and transitory cerebral ischemia are available from only one trial; no increased incidence was found in patients who received high instead of normal FiO 2 [31].…”

Section: Cardiovascular and Cerebrovascular Complicationsmentioning

confidence: 98%

Perioperative Hyperoxyphobia: Justified or Not? Benefits and Harms of Hyperoxia during Surgery

Weenink

Jonge

Hulst

et al. 2020

JCM

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The use of an inspiratory oxygen fraction of 0.80 during surgery is a topic of ongoing debate. Opponents claim that increased oxidative stress, atelectasis, and impaired oxygen delivery due to hyperoxic vasoconstriction are detrimental. Proponents point to the beneficial effects on the incidence of surgical site infections and postoperative nausea and vomiting. Also, hyperoxygenation is thought to extend the safety margin in case of acute intraoperative emergencies. This review provides a comprehensive risk-benefit analysis for the use of perioperative hyperoxia in noncritically ill adults based on clinical evidence and supported by physiological deduction where needed. Data from the field of hyperbaric medicine, as a model of extreme hyperoxygenation, are extrapolated to the perioperative setting. We ultimately conclude that current evidence is in favour of hyperoxia in noncritically ill intubated adult surgical patients.

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“…The reduction of the cerebral flow and neurotoxicity were described after hyperoxia exposure [ 39 ]. The clinical relevance of these effects was not clearly established, as a recent post hoc follow-up study including abdominal surgical patients exposed to 30% vs. 80% oxygen, found no difference in the incidence of stroke or transient cerebral ischemia [ 40 ].…”

Section: Hyperoxia Effects On Surgical Cancer Patients—clinical and Experimental Datamentioning

confidence: 99%

Exploring Hyperoxia Effects in Cancer—From Perioperative Clinical Data to Potential Molecular Mechanisms

Ristescu

Tiron

et al. 2021

Biomedicines

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Increased inspiratory oxygen concentration is constantly used during the perioperative period of cancer patients to prevent the potential development of hypoxemia and to provide an adequate oxygen transport to the organs, tissues and cells. Although the primary tumours are surgically removed, the effects of perioperative hyperoxia exposure on distal micro-metastases and on circulating cancer cells can potentially play a role in cancer progression or recurrence. In clinical trials, hyperoxia seems to increase the rate of postoperative complications and, by delaying postoperative recovery, it can alter the return to intended oncological treatment. The effects of supplemental oxygen on the long-term mortality of surgical cancer patients offer, at this point, conflicting results. In experimental studies, hyperoxia effects on cancer biology were explored following multiple pathways. In cancer cell cultures and animal models, hyperoxia increases the production of reactive oxygen species (ROS) and increases the oxidative stress. These can be followed by the induction of the expression of Brain-derived neurotrophic factor (BDNF) and other molecules involved in angiogenesis and by the promotion of various degrees of epithelial mesenchymal transition (EMT).

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Association between perioperative hyperoxia and cerebrovascular complications after laparotomy—A post‐hoc follow‐up study

Abstract: Stroke or TCI did not seem related to perioperative inspiratory oxygen fraction. Due to few events, this study cannot exclude that perioperative hyperoxia increases risk of mortality, stroke, or TCI after abdominal surgery.

Cited by 10 publications

References 32 publications

Oxygen Saturation and Postoperative Mortality in Patients With Acute Ischemic Stroke Treated by Endovascular Thrombectomy

Oxygen Saturation and Postoperative Mortality in Patients With Acute Ischemic Stroke Treated by Endovascular Thrombectomy

Perioperative Hyperoxyphobia: Justified or Not? Benefits and Harms of Hyperoxia during Surgery

Exploring Hyperoxia Effects in Cancer—From Perioperative Clinical Data to Potential Molecular Mechanisms

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