Adjust Intraoperative Oxygen Therapy for Oxygenation Reasons Only!

Oxygen delivery is a universal component of hospital care, although its ideal titration is still surprisingly elusive.Hypoxemia has well-known deleterious effects on cellular and organ function and overall health.The main purpose of oxygen administration during perioperative care is to prevent or treat hypoxemia.Oxygen administration resulting in tissue oxygen content in excess of physiologic needs (i.e., hyperoxemia) has been proposed to reduce the incidence of various complications, including postoperative nausea and vomiting.The first report supporting intraoperative hyperoxemia for postoperative nausea and vomiting prevention was published more than 20 years ago. 1 Since then, the same authors and others have been investigating this possible use of intraoperative hyperoxemia in various patient populations with inconsistent results.2,3 More recently, concerns of harm related to hyperoxemia have been suggested.4 In this issue of Anesthesiology, Markwei et al. 3 examine the effect of an intraoperative inspired oxygen fraction (FiO 2 ) of 80% vs. 30% to reduce the incidence of postoperative nausea and vomiting in a secondary analysis of a previously published randomized controlled trial.5 The authors included 5,167 patients receiving colorectal surgery at a single hospital in their secondary analysis.Patients were randomly assigned in a cluster-crossover fashion to intraoperative FiO 2 of 80% (n=2,615) or 30% (n=2,552) for the duration of their procedure.Operating rooms at the single site alternated between 80% and 30% FiO 2 at two-week intervals for 39 months.The protocol allowed clinicians to increase inspired oxygen concentrations to maintain oxygen saturation (SpO 2 ) of at least 95%.Postoperative nausea and vomiting were assessed by post-anesthesia care unit (PACU) nurses every 15 minutes for the first two postoperative hours, and ward nurses assessed nausea/vomiting