Supplemental Oxygen in Elective Cesarean Section under Spinal Anesthesia: Handle the Sword with Care

Abstract

The difference in impact on maternal and fetal oxidative stress of supplemental 40% compared to 21% oxygen mandates further large-scale studies that investigate the role of oxygen supplementation during elective CS under spinal anesthesia.

Fetal Hemodynamic Response to Maternal Oxygenation in Normal and Complicated Pregnancies

“…Discrepancies in the duration and volume of inspired oxygen contribute to inconsistent or even contradictory conclusions regarding the benefits of MO. Oxygenation usually lasts approximately 10 minutes during a Cesarean section [2][3][4][5] and a pulmonary vascular response test [8][9][10][11][12][13], but can also be administered in a chronic, intermittent fashion for several days or weeks until delivery [15][16][17]. In this review, we classified oxygenation as short-term (10-20 minutes) and long-term (more than an hour) based on the duration of oxygen administration.…”

Effect of maternal oxygen inhalation on foetal free radical activity: a prospective, randomized trial

“…On the contrary, we compared UA MDA as the primary outcome which is a true indicator of foetal oxidative stress. Thirdly, Yalcin et al evaluated maternal 40% inhalation with air as compared to maternal 50% oxygen inhalation with air in the present study.…”

“…However, the authors did not simultaneously study TAS in neonates and mothers . Yalcin et al evaluated maternal and foetal oxidative stress index (OSI), total antioxidant capacity (TAC) and total oxidant status (TOS) in mothers breathing air or 40% oxygen. The results were different as compared to the present study due to the following reasons.…”

“…The results were different as compared to the present study due to the following reasons. Firstly, we used maternal oxygen inhalation for a brief period, that is commencing after SAB till the delivery of the foetus (~10.3 min) which was of shorter duration as compared to time of skin incision till the end of the surgery (approximately 1 h) by Yalcin et al Secondly, Yalcin et al considered maternal post‐operative OSI as primary outcome and reported an increase in UA TOS and OSI and decrease in TAS levels, but the study was not powered to evaluate these parameters. The absolute difference in levels was minimal (21% oxygen vs. 40% oxygen; TAS 0.98 (0.15) vs. 0.92 (1.03), TOS 3.07 (0.97) vs. 3.15 (1.03), OSI 0.24 (0.04) vs. 0.25 (0.06), respectively.…”

Assessment of Apoptotic Activity Dysregulation and Oxidative Stress in the Development of Epithelial Ovarian Cancer: A Case-Controlled Descriptive Analysis

“…The serum oxidative stress parameters, including TAS, TOS and OSI levels, were measured as described previously [11,19,20]. TAS was measured via the spectrophotometric technique using commercial kits (Rel® Assay Diagnostics).…”