Supplemental Intraoperative Oxygen Augments Antimicrobial and Proinflammatory Responses of Alveolar Macrophages

Kotani, Naoki; Hashimoto, Hiroshi; Sessler, Daniel I.; Muraoka, Masahiro; Hashiba, Eiji; Kubota, Takeshi; Matsuki, Akitomo

doi:10.1097/00000542-200007000-00008

Cited by 74 publications

(53 citation statements)

References 4 publications

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“…3B) (table 3). 55,56,60,61,63,64,69,70,72 Six articles reported on atelectasis using chest radiographs and/or thoracic computed tomography scans for diagnosis (table 4); however, two of those 69,70 were subgroup analyses reporting on the same outcomes as the original larger study. 63 Thus, data from four trials, two small 56,60 and two large, 63,64 could be combined (fig.…”

Section: Perioperative Medicinementioning

confidence: 99%

Effect of Intraoperative High Inspired Oxygen Fraction on Surgical Site Infection, Postoperative Nausea and Vomiting, and Pulmonary Function

et al. 2013

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Background: Intraoperative high inspired oxygen fraction (FIo 2 ) is thought to reduce the incidence of surgical site infection (SSI) and postoperative nausea and vomiting, and to promote postoperative atelectasis. Methods: The authors searched for randomized trials (till September 2012) comparing intraoperative high with normal FIo 2 in adults undergoing surgery with general anesthesia and reporting on SSI, nausea or vomiting, or pulmonary outcomes. Results: The authors included 22 trials (7,001 patients) published in 26 reports. High FIo 2 ranged from 80 to 100% (median, 80%); normal FIo 2 ranged from 30 to 40% (median, 30%). In nine trials (5,103 patients, most received prophylactic antibiotics), the incidence of SSI decreased from 14.1% with normal FIo 2 to 11.4% with high FIo 2 ; risk ratio, 0.77 (95% CI, 0.59-1.00). After colorectal surgery, the incidence of SSI decreased from 19.3 to 15.2%; risk ratio, 0.78 (95% CI, 0.60-1.02). In 11 trials (2,293 patients), the incidence of nausea decreased from 24.8% with normal FIo 2 to 19.5% with high FIo 2 ; risk ratio, 0.79 (95% CI, 0.66-0.93). In patients receiving inhalational anesthetics without prophylactic antiemetics, high FIo 2 provided a significant protective effect against both nausea and vomiting. Nine trials (3,698 patients) reported on pulmonary outcomes. The risk of atelectasis was not increased with high FIo 2 . Conclusions: Intraoperative high FIo 2 further decreases the risk of SSI in surgical patients receiving prophylactic antibiotics, has a weak beneficial effect on nausea, and does not increase the risk of postoperative atelectasis. IT has been claimed that patients undergoing surgery with general anesthesia were benefiting from a higher than normal inspired oxygen fraction (FIo 2 ).1,2 Some authors have suggested that a high FIo 2 was a simple, inexpensive, and lowrisk intervention, and that the broader use of this technique should be encouraged in patients undergoing major abdominal procedures.3 Randomized trials have reported on a reduced risk of surgical site infection (SSI) in patients who were ventilated with 80% FIo 2 during surgery. 4,5 It was also shown that patients who were ventilated with high FIo 2 intraoperatively had a reduced incidence of postoperative nausea and vomiting (PoNV). 6,7 other authors were more cautious. 8,9 Skepticism has been partly related to the fact that high FIo 2 may have deleterious What This Article Tells Us That Is New• Intraoperative high inspired oxygen fraction decreases the risk of surgical site infection in surgical patients receiving prophylactic antibiotics, has a weak beneficial effect on nausea, and does not increase the risk of postoperative atelectasis

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Section: Perioperative Medicinementioning

confidence: 99%

Effect of Intraoperative High Inspired Oxygen Fraction on Surgical Site Infection, Postoperative Nausea and Vomiting, and Pulmonary Function

et al. 2013

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“…Poorly-aerated regions were also comparable between the groups (9.5 ± 4.4% in the patients given 30% oxygen vs. 10.3 ± 4.2% in the patients given 80% oxygen). From Kotani et al [86] the fraction of alveolar macrophages ingesting opsonized and nonopsonized particles during anesthesia with 100% (n = 30, circles) and 30% (n = 30, squares) inspired oxygen. Asterisks (*) indicate statistically significant differences (P < 0.05) from elapsed time zero in each group; pounds signs (#) identify significant differences (P < 0.01) between the two groups.…”

Section: Discussionmentioning

confidence: 99%

“…Hyperoxia, in contrast, provokes pulmonary expression of inflammatory cytokines which in turn helps maintain phagocytosis and oxidative killing by alveolar macrophages (Fig. 3) [86]. It is likely that this response helps patients resist pneumonia, but could well become harmful over long periods of time or in the context of other factors promoting pulmonary inflammation.…”

Section: Supplemental Oxygen Is Safementioning

confidence: 99%

Non-pharmacologic Prevention of Surgical Wound Infection

Sessler

2006

Anesthesiology Clinics of North America

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Wound infections are serious and relatively common postoperative complications. They are generally detected five to nine days after surgery and are usually attributed, even by surgeons, to poor surgical technique or failure to maintain sterility. However, it has been known for decades that all wounds become contaminated, often by bacteria from the skin or within the patient, and that it is host defense mechanisms that prevent most contamination from developing into clinical infections. Host defense is especially important during the initial hours following contamination, i.e., the immediate perioperative period.As might thus be expected, factors that improve host defense reduce infection risk. Many of these are under the direct control of anesthesiologists and are at least as important as appropriate use of prophylactic antibiotics, which halve infection risk [1]. This article will review nonpharmacologic methods of reducing infection risk, with special emphasis on methods available to anesthesiologists.

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“…Relatos entre a associação de concentrações elevadas de oxigênio inspirado e colapso pulmonar têm sido descritos há pelo menos 50 anos 8 . Apesar de os efeitos benéficos serem atribuídos ao uso da concentração alta de oxigênio durante a anestesia, como a redução de náusea e vômito pós-operatório 37 , ao aumento das respostas pró-inflamató-rias e atividade antimicrobiana dos macrófagos alveolares 38 , à possível diminuição na infecção da ferida cirúrgica no pós-operatório 39 e à prevenção de episódios de hipoxemia, as atelectasias desenvolvidas no período intra-operatório não são prontamente revertidas no pós-operatório e podem persistir por vários dias, aumentando o tempo de ventilação mecânica, a necessidade de fisioterapia respiratória, a duração da internação hospitalar e os custos. Avaliando cautelosamente esses dados, evidências atuais não sugerem que possíveis benefícios do uso de altas concentrações de oxigênio possam contrabalançar as conseqüências deleté-rias de complicações pulmonares pós-operatórias.…”

Section: Mecanismos Do Colapso Pulmonar Intra-operatóriounclassified

“…There have been reports in the literature associating high inspired fractions of oxygen and pulmonary collapse for at least fifty years 8 . Although some benefits have been attributed to the use of high oxygen concentrations during anesthesia, such as reduction in postoperative nausea and vomiting 37 , increase in pro-inflammatory responses and antimicrobiotic activity of alveolar macrophages 38 , possible reduction in postoperative infection of the surgical wound 39 and prevention of episodes of hypoxemia, postoperative atelectasis do not reverse immediately and might persist for several days increasing the time of mechanical ventilation required, the need of respiratory therapy, increased length of hospita-lization and health care costs. Weighing those data carefully, current evidence does not indicate that the possible benefits of the use of high oxygen concentrations can overcome the detrimental consequences of postoperative pulmonary complications.…”

Section: Mechanisms Of Intraoperative Pulmonary Collapsementioning

confidence: 99%

Atelectasias durante anestesia: fisiopatologia e tratamento

Malbouisson¹,

Humberto²,

Rodrigues³

et al. 2008

Rev. Bras. Anestesiol.

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Rev Bras AnestesiolARTIGO DE REVISÃO 2008; 58: 1: 73-83 REVIEW ARTICLE RESUMOMalbouisson LMS, Humberto F, Rodrigues RR, Carmona MJC, Auler Jr JOC -Atelectasias durante Anestesia: Fisiopatologia e Tratamento. JUSTIFICATIVA E OBJETIVOS:O colapso pulmonar intra-operatório é uma complicação de elevada incidência em pacientes submetidos à intervenção cirúrgica sob anestesia geral com relaxamento/paralisia da musculatura. Essa complicação está associada à piora das trocas gasosas no intra-operatório e, em alguns casos, necessidade de suporte respiratório prolongado no perío-do pós-operatório. Os objetivos deste estudo foram revisar os aspectos fisiopatológicos da formação de atelectasias durante anestesia geral e as possíveis manobras terapêuticas para prevenir e tratar essa complicação.CONTEÚDO: Nesta revisão, os conceitos sobre a incidência de atelectasias intra-operatórias, os fatores relacionados com o seu desenvolvimento, tanto mecânicos quanto associados ao ajuste do respirador durante procedimento cirúrgico, os aspectos do diagnós-tico e as estratégias de prevenção e tratamento foram abordados de maneira sistemática. CONCLUSÕES:A compreensão dos mecanismos relacionados com o desenvolvimento do colapso pulmonar durante o período intra-operatório, assim como o seu tratamento, pode contribuir para a redução da incidência de complicações pulmonares pós-operatórias, o tempo de recuperação e os custos hospitalares.Unitermos: COMPLICAÇÕES: atelectasia; colapso pulmonar; VEN-TILAÇÃO: controlada mecânica, manobra de recrutamento alveolar, pressão positiva ao final da expiração. SUMMARYMalbouisson LMS, Humberto F, Rodrigues RR, Carmona MJC, Auler Jr JOC -Atelectasis During Anesthesia: Pathophysiology and Treatment. BACKGROUND AND METHODS:The incidence of intraoperative pulmonary collapse is elevated in patients undergoing surgery under general anesthesia with muscle relaxation/paralysis. This complication is associated with worsening intraoperative gas exchange and, in some cases, the need for prolonged postoperative respiratory support. The objective of this report was to review the pathophysiological aspects of atelectasis during general anesthesia and possible therapeutic maneuvers that could prevent and treat this complication. CONTENTS:This review discusses the concepts about the incidence of intraoperative atelectasis, factors that influence their development, both mechanical and those related to mechanical ventilator settings during the surgery, diagnostic criteria, and strategies to prevent and treat this complication. CONCLUSIONS:Understanding of the mechanisms related with the development of intraoperative pulmonary collapse, as well as its treatment, can contribute to reduce the incidence of postoperative pulmonary complications, the length of recovery and hospital costs.

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Supplemental Intraoperative Oxygen Augments Antimicrobial and Proinflammatory Responses of Alveolar Macrophages

Cited by 74 publications

References 4 publications

Effect of Intraoperative High Inspired Oxygen Fraction on Surgical Site Infection, Postoperative Nausea and Vomiting, and Pulmonary Function

Effect of Intraoperative High Inspired Oxygen Fraction on Surgical Site Infection, Postoperative Nausea and Vomiting, and Pulmonary Function

Non-pharmacologic Prevention of Surgical Wound Infection

Atelectasias durante anestesia: fisiopatologia e tratamento

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