Key result
Only 2% (95% CI 0.4-5.7) of anaesthetists administered an average intraoperative fraction of inspired oxygen of at least 0.8, indicating most routinely administer an intermediate level of oxygen.
Why the study?
Optimal intraoperative oxygen regimens are unknown, international guidelines conflict, and practice patterns had not been quantified in Australia and New Zealand.
Observational (n=150)
Yes
Most anaesthetists in Australia and New Zealand routinely administer an intermediate level of oxygen (median FiO2 0.47) during prolonged non-cardiac surgery, rather than the liberal oxygen therapy (FiO2 ≥ 0.8) recommended by the WHO.
The practice of anaesthetists relating to the administration of intraoperative oxygen has not been previously quantified in Australia and New Zealand. The optimal regimen of intraoperative oxygen administration to patients undergoing surgery under general anaesthesia is not known, and international recommendations for oxygen therapy are contradictory; the World Health Organization (WHO) recommend administering an intraoperative fraction of inspired oxygen of at least 0.8, while the World Federation of Societies of Anaesthesiologists, British Thoracic Society, and Thoracic Society of Australia and New Zealand recommend a more restrictive approach. We conducted a prospective observational study to describe the pattern of intraoperative oxygen administration among anaesthetists in Australia and New Zealand and, second, to determine the proportion of anaesthetists who administer intraoperative inspired oxygen in accordance with the WHO recommendations. We identified 150 anaesthetists from ten metropolitan hospitals in Australia and New Zealand and observed the patterns of intraoperative oxygen administration to American Society of Anesthesiologists physical status classification (ASA) 3 or 4 patients undergoing prolonged surgery under general anaesthesia. The median (interquartile range) intraoperative time-weighted mean fraction of inspired oxygen (FiO 2 ) for all participants in the study was 0.47 (0.40–0.55). Three out of 150 anaesthetists (2%, 95% confidence interval 0.4 to 5.7) administered an average intraoperative FiO 2 of at least 0.8. These findings indicate that most anaesthetists routinely administer an intermediate level of oxygen for ASA 3 or 4 adult patients undergoing prolonged surgery in Australia and New Zealand, rather than down-titrating inspired oxygen to a target pulse oximetry reading (SpO 2 ) or administering liberal perioperative oxygen therapy in line with the current WHO recommendation.
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Frei et al. (2023) conducted an observational in ASA 3 or 4 patients undergoing prolonged surgery under general anaesthesia (n=150). Intraoperative oxygen administration was evaluated on Proportion of anaesthetists administering an average intraoperative FiO2 of at least 0.8 (WHO recommendation) (95% CI 0.4-5.7). Only 2% (95% CI 0.4-5.7) of anaesthetists administered an average intraoperative fraction of inspired oxygen of at least 0.8, indicating most routinely administer an intermediate level of oxygen.
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