Oxygen administration for postoperative surgical patients: a narrative review

Abstract

Most postoperative surgical patients routinely receive supplemental oxygen therapy to prevent the potential development of hypoxemia due to incomplete lung re-expansion, reduced chest wall, and diaphragmatic activity caused by surgical site pain, consequences of hemodynamic impairment, and residual effects of anesthetic drugs (most notably residual neuromuscular blockade), which may result in atelectasis, ventilation–perfusion mismatch, alveolar hypoventilation, and impaired upper airway patency. Additionally, the World Health Organization guidelines for reducing surgical site infection have recommended the perioperative administration of high-dose oxygen, including during the immediate postoperative period. However, supplemental oxygen and hyperoxemia also have harmful effects on the respiratory and cardiovascular systems, with several clinical studies having reported an association between high perioperative oxygen administration and worse clinical outcomes. Recently, the increased availability of new and short-acting anesthetic drugs, comprehensive pharmacological knowledge, postoperative multimodal analgesia, and new minimally invasive surgery options could result in lower incidences of postoperative hypoxemia. Moreover, recommendations promoting high oxygen administration to prevent surgical site infections have been challenged, considering the lack of scientific investigations, and have not been widely accepted. Given the potential harmful effects of hyperoxemia, routine postoperative oxygen administration might not be recommended. Recent clinical studies have indicated that a conservative approach to oxygen therapy, where oxygen administration is titrated to achieve slightly lower oxygen levels than usual, could be safely implemented and decrease acutely ill patients’ susceptibility to hyperoxemia. Based on current evidence, appropriate monitoring, including peripheral oxygen saturation, and oxygen titration should be required during postoperative oxygen administration to avoid both hypoxemia and hyperoxemia. Future trials should therefore focus on determining the optimal oxygen target during postoperative care.

Short term cognitive function after sevoflurane anesthesia in patients suspect to obstructive sleep apnea syndrome: an observational study

“…Thus 79% of low risk patients and 96% of moderate to high risk patients presented a hypoxic episode if the critical value is considered to be 95% oxygen saturation. Although this phenomenon is unwanted, it appears regularly in the perioperative setting and is a well-known complication after the operation process [ 38 , 39 ]. These hypoxic episodes can persist for more than 16 h and have been described within the second and third night after operation as well [ 40 ].…”

Rational Use of Oxygen in COVID-19 Pandemic – Are We Doing Enough?

“…Injudicious hyperoxemic therapy in surgical patients can increase the risk of absorption atelectasis, worsen ventilation-perfusion matching, reduce cardiac output, and delay the recognition of declining lung function in the post-anesthesia care unit. 18 Even in patients admitted to the hospital with COVID-19-related acute respiratory failure, a recent expert consensus statement suggests maintaining a target SpO 2 of only more than 90%. 19 Another set of recommendations for managing acute respiratory failure in patients with COVID-19 in LMICs suggests maintaining SpO 2 at 88 to 95%.…”

“…Injudicious hyperoxemic therapy in surgical patients can increase the risk of absorption atelectasis, worsen ventilation-perfusion matching, reduce cardiac output, and delay the recognition of declining lung function in the post-anesthesia care unit. 18 …”

Postoperative Follow-Up and Recovery after Abdominal Surgery

“…The impact of a deficient oxygenation is systemic [16,17], manifested at the level of the operative site (with the hypooxygenation of an anastomosis for example), at the cardiac level (decompensation of an ischemic heart disease), cerebral, etc. However supplemental oxygen should not be administered on a regular basis, but only when the oximetry drops under 90-92%, due to secondary risks of hyperoxia [18,19]. The presence of prolonged, productive cough, especially when associated with fever and altered general condition, becomes an indication for a chest X-ray in order to capture changes responsible for the occurrence of this symptomatology and take appropriate measures [20,21].…”