Inadvertent hyperoxia during intraoperative care in neonates: a case-series study

Wakimoto, Mayuko; Miller, Rebecca; Chenault, Kristin; Tobias, Joseph D.

doi:10.1007/s00540-019-02720-7

Cited by 3 publications

(5 citation statements)

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“…Smatra se da hiperoksija naročito oštećuje mozak u razvoju. Klinički dokazi ukazuju da hronična hiperoksija kod prevremeno rođene dece izaziva retinopatiju prematuriteta, intraventrikularnu hemoragiju, nekrotizirajući enterokolitis, bronhoplulmonalnu displaziju, kognitivne probleme i maligne bolesti u kasnijem razvoju 30 . Savremeni vodiči za izvođenje reanimacionih postupaka u porođajnim salama kod novorođene dece sugerišu ventilaciju sobnim vazduhom u slučaju respiratornog aresta, uz preporuku da saturacija hemoglobina kiseonikom za prevremeno rođenu decu bude u opsegu 90-95% 31,32 .…”

Section: Specifičnosti Hiperoksije Kod Deceunclassified

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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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Section: Specifičnosti Hiperoksije Kod Deceunclassified

“…Smatra se da je redukovana endogena antioksidantna aktivnost u dečijem uzrastu glavni krivac za neurotoksičnost anestetičkih agenasa 30 . Izloženost hroničnoj hiperoksiji u neonatalnom uzrastu smatra se udruženim etiološkim za nastanak cerebralne paralize u ovoj specifičnoj grupi bolesnika 33 .…”

Section: Specifičnosti Hiperoksije Kod Deceunclassified

When does the oxygen cease to be a remedy?

Stevanović,

Mandraš,

Krunić

2023

Galenika Med J

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“…It must be noted, however, that a large, single centre, retrospective study found that a high partial arterial oxygen concentration (partial arterial oxygen > 350 mmHg, or > 250 mmHg in sicker children) at the time of the intensive care admission was an independent risk factor for increased mortality [32]. Until further studies clarify these findings, anesthesiologists may need to titrate the delivered amount of oxygen, as inadvertent intraoperative hyperoxia (partial arterial oxygen > 200 mmHg) is common [33].…”

Section: Normoxemiamentioning

confidence: 99%

The importance of maintaining normal perioperative physiological parameters in children during anaesthesia

2021

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Every year, millions of neonates, infants and young children need general anesthesia for a variety of procedures. As pediatric anesthesia remains at high risk of perioperative morbidity and mortality, attention has been directed towards the anesthesia training and the anesthetics safety. We are now reassured about the relatively safeness of the anesthetic drugs, but the safest intraoperative conduct has still to be determined. In the absence of clear evidence, it appears logical to prevent perturbations of the child “baseline”, by avoiding preoperative distress, maintaining normal intraoperative parameters and preventing postoperative discomfort. Recently, ten “N” principles (no fear/awareness, normovolemia, normotension, normal heart rate, normoxemia, normocapnia, normonatremia, normoglycemia, normotermia and no pain/nausea/vomiting/emergence delirium) have been proposed as the base of a safer anesthesia care. The current paper aims to summarize the current evidence behind the “10-Ns” rational and to help guide anesthesiologists in their practice.

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“…Also, during maintenance of anesthesia, it is common practice to administer a higher FiO 2 than the infant would otherwise need. 1 Studies in adults have demonstrated that the time to desaturation (<90%) while handling the airway is increased twofold with an FiO 2 of 100% compared with 60%. 2 Further, in children the time to an eventual decrease in oxygen saturation has been demonstrated to depend on the duration of preoxygenation.…”

Section: Introductionmentioning

confidence: 99%

“…The routine of using a high fraction of inspired oxygen (FiO 2 ) for preoxygenation during induction of anesthesia aimed to reduce the risk of hypoxemia in newborn infants as well as in older patients. Also, during maintenance of anesthesia, it is common practice to administer a higher FiO 2 than the infant would otherwise need 1 . Studies in adults have demonstrated that the time to desaturation (<90%) while handling the airway is increased twofold with an FiO 2 of 100% compared with 60% 2 .…”

Section: Introductionmentioning

confidence: 99%

Randomized controlled trial of low vs high oxygen during neonatal anesthesia: Oxygenation, feasibility, and oxidative stress

Karlsson

Sporre

Fredén

et al. 2022

Pediatric Anesthesia

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Background: To reduce risk for intermittent hypoxia a high fraction of inspired oxygen is routinely used during anesthesia induction. This differs from the cautious dosing of oxygen during neonatal resuscitation and intensive care and may result in significant hyperoxia. Aim:In a randomized controlled trial, we evaluated oxygenation during general anesthesia with a low (23%) vs a high (80% during induction and recovery, and 40% during maintenance) fraction of inspired oxygen, in newborn infants undergoing surgery.Method: Thirty-five newborn infants with postconceptional age of 35-44 weeks were included (17 infants in low and 18 in high oxygen group). Oxygenation was monitored by transcutaneous partial pressure of oxygen, pulse oximetry, and cerebral oxygenation. Predefined SpO2 safety targets dictated when to increase inspired oxygen.Results: At start of anesthesia, oxygenation was similar in both groups. Throughout anesthesia, the high oxygen group displayed significant hyperoxia with higher (difference−20.3 kPa, 95% confidence interval (CI)-28.4 to 12.2, p < .001) transcutaneous partial pressure of oxygen values than the low oxygen group. While SpO2 in the low oxygen group was lower (difference − 5.8%, 95% CI -9.3 to -2.4, p < .001) during anesthesia, none of the infants spent enough time below SpO 2 safety targets to mandate supplemental oxygen, and cerebral oxygenation was within the normal range and not statistically different between the groups. Analysis of the oxidative stress biomarker urinary F 2 -Isoprostane revealed no differences between the low and high oxygen group. Conclusion:We conclude that in healthy newborn infants, use of low oxygen during general anesthesia was feasible, while the prevailing practice of using high levels of inspired oxygen resulted in significant hyperoxia. The trade-off between careful dosing of oxygen and risks of hypo-and hyperoxia in neonatal anesthesia should be further examined.

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Inadvertent hyperoxia during intraoperative care in neonates: a case-series study

Cited by 3 publications

References 10 publications

When does the oxygen cease to be a remedy?

When does the oxygen cease to be a remedy?

The importance of maintaining normal perioperative physiological parameters in children during anaesthesia

Randomized controlled trial of low vs high oxygen during neonatal anesthesia: Oxygenation, feasibility, and oxidative stress

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