Perioperative supplemental oxygen and oxidative stress in patients undergoing moderate- to high-risk major abdominal surgery – A subanalysis of randomized clinical trial

Reiterer, Christian; Fleischmann, Edith; Taschner, Alexander; Adamowitsch, Nikolas; Sonnenburg, Markus Falkner von; Gráf, Alexandra; Fraunschiel, Melanie; Starlinger, Patrick; Goschin, Julius; Kabon, Barbara

doi:10.1016/j.jclinane.2021.110614

Cited by 5 publications

(5 citation statements)

References 43 publications

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“…Similar postoperative responses in oxidative stress were also observed in another secondary analysis of our main trial [40]. In detail, we have shown that oxidative stress, assessed via oxidation-reduction potential, which is a reliable marker for oxidative stress [41], significantly increased in the overall study population [40]. Furthermore, there was a simultaneous decrease in the oxidation-reduction capacity [40].…”

Section: Discussionsupporting

confidence: 81%

“…Surgery is associated with significantly higher cortisol concentrations, inflammatory response and oxidative stress [37][38][39]. Similar postoperative responses in oxidative stress were also observed in another secondary analysis of our main trial [40]. In detail, we have shown that oxidative stress, assessed via oxidation-reduction potential, which is a reliable marker for oxidative stress [41], significantly increased in the overall study population [40].…”

Section: Discussionsupporting

confidence: 79%

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Perioperative Supplemental Oxygen and Postoperative Copeptin Concentrations in Cardiac-Risk Patients Undergoing Major Abdominal Surgery—A Secondary Analysis of a Randomized Clinical Trial

Taschner

Kabon

Gráf

et al. 2022

JCM

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Noncardiac surgery is associated with hemodynamic perturbations, fluid shifts and hypoxic events, causing stress responses. Copeptin is used to assess endogenous stress and predict myocardial injury. Myocardial injury is common after noncardiac surgery, and is often caused by myocardial oxygen demand-and-supply mismatch. In this secondary analysis, we included 173 patients at risk for cardiovascular complications undergoing moderate- to high-risk major abdominal surgery. Patients were randomly assigned to receive 80% or 30% oxygen throughout surgery and the first two postoperative hours. We evaluated the effect of supplemental oxygen on postoperative Copeptin concentrations. Copeptin concentrations were measured preoperatively, within two hours after surgery, on the first and third postoperative days. In total, 85 patients received 0.8 FiO2, and 88 patients received 0.3 FiO2. There was no significant difference in postoperative Copeptin concentrations between both study groups (p = 0.446). Copeptin increased significantly within two hours after surgery, compared with baseline in the overall study population (estimated effect: −241.7 pmol·L−1; 95% CI −264.4, −219.1; p < 0.001). Supplemental oxygen did not significantly attenuate postoperative Copeptin release. Copeptin concentrations showed a more immediate postoperative increase compared with previously established biomarkers. Nevertheless, Copeptin concentrations did not surpass Troponin T in early determination of patients at risk for developing myocardial injury after noncardiac surgery.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionsupporting

confidence: 79%

Perioperative Supplemental Oxygen and Postoperative Copeptin Concentrations in Cardiac-Risk Patients Undergoing Major Abdominal Surgery—A Secondary Analysis of a Randomized Clinical Trial

Taschner

Kabon

Gráf

et al. 2022

JCM

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“…Former studies showed that the administration of supplemental oxygen leads to increased postoperative mortality, larger infarct size in patients with ST-segment elevation myocardial infarction, increased cerebral infarct size, and higher mortality in intensive care patients (1,4,6). However, our main trial and also other trials did not detect any harmful effects when 80% of oxygen was given, specifically in the perioperative period (5,(7)(8)(9). In fact, recent follow-up studies show that higher oxygen concentrations were not associated with higher mortality (10,11).…”

Section: Introductionmentioning

confidence: 55%

“…We conducted the trial according to the Declaration of Helsinki and Good Clinical Practice. The results of the primary outcome and several sub-analyses were published previously ( 7 , 17–19 ).…”

Section: Methodsmentioning

confidence: 99%

Hemodynamic effects of intraoperative 30% versus 80% oxygen concentrations: an exploratory analysis

et al. 2023

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BackgroundSupplemental oxygen leads to an increase in peripheral vascular resistance which finally increases systemic blood pressure in healthy subjects and patients with coronary artery disease, heart failure, undergoing heart surgery, and with sepsis. However, it is unknown whether this effect can also be observed in anesthetized patients having surgery. Thus, we evaluated in this exploratory analysis of a randomized controlled trial the effect of 80% versus 30% oxygen on intraoperative blood pressure and heart rate.MethodsWe present data from a previous study including 258 patients, who were randomized to a perioperative inspiratory FiO2 of 0.8 (128 patients) versus 0.3 (130 patients) for major abdominal surgery. Continuous arterial blood pressure values were recorded every three seconds and were exported from the electronic anesthesia record system. We calculated time-weighted average (TWA) and Average Real Variability (ARV) of mean arterial blood pressure and of heart rate.ResultsThere was no significant difference in TWA of mean arterial pressure between the 80% (80 mmHg [76, 85]) and 30% (81 mmHg [77, 86]) oxygen group (effect estimate −0.16 mmHg, CI –1.83 to 1.51; p = 0.85). There was also no significant difference in TWA of heart rate between the 80 and 30% oxygen group (median TWA of heart rate in the 80% oxygen group: 65 beats.min−1 [58, 72], and in the 30% oxygen group: 64 beats.min−1 [58; 70]; effect estimate: 0.12 beats.min−1, CI –2.55 to 2.8, p = 0.94). Also for ARV values, no significant differences between groups could be detected.ConclusionIn contrast to previous results, we did not observe a significant increase in blood pressure or a significant decrease in heart rate in patients, who received 80% oxygen as compared to patients, who received 30% oxygen during surgery and for the first two postoperative hours. Thus, hemodynamic effects of supplemental oxygen might play a negligible role in anesthetized patients.Clinical Trail Registrationhttps://clinicaltrials.gov/ct2/show/NCT03366857?term=vienna&cond=oxygen&draw=2&rank=1

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“…Smanjen je protok kroz koronarne krvne sudove i povećana potrošnja kiseonika od strane miokarda, te postoji sklonost ka ishemiji 10 . Globalna periferna vazokonstrikcija doprinosi većoj produkciji laktata koji su povišeni u hiperoksiji 11 . Zbog ovih činjenica Evropsko udruženje kardiologa revidiralo je prethodne vodiče, pa se dodatni kiseonik preporučuje samo kod pacijenata sa STEMI (ST-elevation myocardial infarction, STEMI) i nonSTEMI infarktom miokarda, kojima je SpO 2 < 90% ili ako pokazuju znake respiratornog distresa 12,13 .…”

Section: Efekti Kiseonika Na Kardiovaskularni Sistemunclassified

When does the oxygen cease to be a remedy?

Stevanović,

Mandraš,

Krunić

2023

Galenika Med J

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Oxygen has been considered a potentially life-saving drug in life-threatening situations for decades. It is crucial in the perioperative period, where it is used daily by millions of surgical patients of all ages. Iatrogenic hyperoxia is as damaging as hypoxia, especially in young children and neonates. There is a growing awareness about this problem. Significant discoveries about the effect of oxygen on oxidative stress and cellular damage due to oxygen intoxication must contribute to developing hyperoxia monitoring, oxygen dosing guidelines, and revising the safe limits of hyperoxia. The consequences of hyperoxia can be irreversible damage to the vulnerable organs (lungs and brain), which mainly affects developing organisms.

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Perioperative supplemental oxygen and oxidative stress in patients undergoing moderate- to high-risk major abdominal surgery – A subanalysis of randomized clinical trial

Cited by 5 publications

References 43 publications

Perioperative Supplemental Oxygen and Postoperative Copeptin Concentrations in Cardiac-Risk Patients Undergoing Major Abdominal Surgery—A Secondary Analysis of a Randomized Clinical Trial

Perioperative Supplemental Oxygen and Postoperative Copeptin Concentrations in Cardiac-Risk Patients Undergoing Major Abdominal Surgery—A Secondary Analysis of a Randomized Clinical Trial

Hemodynamic effects of intraoperative 30% versus 80% oxygen concentrations: an exploratory analysis

When does the oxygen cease to be a remedy?

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