Effectiveness of 80% vs 30-35% fraction of inspired oxygen in patients undergoing surgery: an updated systematic review and meta-analysis.

Abstract:

BACKGROUND:In 2016, the World Health Organization (WHO) strongly recommended the use of a high fraction of inspired oxygen (FiO2) in adult patients undergoing general anaesthesia to reduce the risk of surgical site infection (SSI). Since then, further trials have been published, trials included previously have come under scrutiny, and one article was retracted. We updated the systematic review on which the recommendation was based. METHODS:We performed a systematic literature search from January 1990 to April 2018 for RCTs comparing the effect of high (80%) vs standard (30-35%) FiO2 on the incidence of SSI. Studies retracted or under investigation were excluded. A random effects model was used for meta-analyses; the sources of heterogeneity were explored using meta-regression. RESULTS:Of 21 RCTs included, six were newly identified since the publication of the WHO guideline review; 17 could be included in the final analyses. Overall, no evidence for a reduction of SSI after the use of high FiO2 was found [relative risk (RR): 0.89; 95% confidence interval (CI): 0.73-1.07]. There was evidence that high FiO2 was beneficial in intubated patients [RR: 0.80 (95% CI: 0.64-0.99)], but not in non-intubated patients [RR: 1.20 (95% CI: 0.91-1.58); test of interaction; P=0.048]. CONCLUSIONS:The WHO updated analyses did not show definite beneficial effect of the use of high perioperative FiO2, overall, but there was evidence of effect of reducing the SSI risk in surgical patients under general anaesthesia with tracheal intubation. However, the evidence for this beneficial effect has become weaker and the strength of the recommendation needs to be reconsidered.

journal_name

Br J Anaesth

authors

de Jonge S,Egger M,Latif A,Loke YK,Berenholtz S,Boermeester M,Allegranzi B,Solomkin J

doi

10.1016/j.bja.2018.11.024

subject

Has Abstract

pub_date

2019-03-01 00:00:00

pages

325-334

issue

3

eissn

0007-0912

issn

1471-6771

pii

S0007-0912(18)31346-1

journal_volume

122

pub_type

meta分析
  • Cytokines and the immunomodulatory function of the vagus nerve.

    abstract::Cytokine synthesis and release is an essential component of the innate immune system, but inappropriate, excessive production results in a generalized systemic inflammatory response which damages distant organs. Recent research has identified an immunomodulatory function of the vagus nerve whereby activation of the ef...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章,评审

    doi:10.1093/bja/aep037

    authors: Johnston GR,Webster NR

    更新日期:2009-04-01 00:00:00

  • The Ageing Brain: Age-dependent changes in the electroencephalogram during propofol and sevoflurane general anaesthesia.

    abstract:BACKGROUND:Anaesthetic drugs act at sites within the brain that undergo profound changes during typical ageing. We postulated that anaesthesia-induced brain dynamics observed in the EEG change with age. METHODS:We analysed the EEG in 155 patients aged 18-90 yr who received propofol (n=60) or sevoflurane (n=95) as the ...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章

    doi:10.1093/bja/aev213

    authors: Purdon PL,Pavone KJ,Akeju O,Smith AC,Sampson AL,Lee J,Zhou DW,Solt K,Brown EN

    更新日期:2015-07-01 00:00:00

  • Comparison of isoflurane and propofol-fentanyl anaesthesia in a swine model of asphyxia.

    abstract:BACKGROUND:There have been few studies comparing the response to asphyxia and the effectiveness of typical cardiopulmonary resuscitation (CPR) using exogenous epinephrine administration and manual closed-chest compression between total intravenous anaesthesia (TIVA) and inhalational anaesthesia. METHODS:Twenty pigs we...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章

    doi:10.1093/bja/aeg259

    authors: Kurita T,Morita K,Kazama T,Sato S

    更新日期:2003-12-01 00:00:00

  • Comparison of bispectral index, 95% spectral edge frequency and approximate entropy of the EEG, with changes in heart rate variability during induction of general anaesthesia.

    abstract::We have compared bispectral index (BIS), 95% spectral edge frequency (SEF) and approximate entropy (ApEn) in 37 patients during induction and recovery from a short general anaesthetic. Heart rate variability (HRV) was also compared during induction only. These indices were noted at the start of induction, when a syrin...

    journal_title:British journal of anaesthesia

    pub_type: 临床试验,杂志文章

    doi:10.1093/bja/82.5.666

    authors: Sleigh JW,Donovan J

    更新日期:1999-05-01 00:00:00

  • Modification of the iso-shunt lines for low inspired oxygen concentrations.

    abstract::Arterial PO2 (PaO2) has been related to inspired oxygen concentration (FIO2 range 0.21-0.60) in 20 patients, breathing spontaneously, while recovering from a range of conditions treated in an intensive therapy unit. There was a highly significant linear trend (P < 0.001) for the mean venous admixture ("virtual shunt")...

    journal_title:British journal of anaesthesia

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1093/bja/72.5.515

    authors: Petros AJ,Doré CJ,Nunn JF

    更新日期:1994-05-01 00:00:00

  • General anaesthesia for carbon dioxide laser surgery within the airway. A review.

    abstract::Carbon dioxide laser surgery in the airway presents the anaesthetist with new problems. The mode of action of carbon dioxide lasers and its effects on anaesthetic agents and equipment are described. Complications, especially of fire hazards in the airway, and methods of avoiding them are set out in detail. Various ana...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章,评审

    doi:10.1093/bja/59.12.1610

    authors: Paes ML

    更新日期:1987-12-01 00:00:00

  • Blood concentrations of nitrous oxide in theatre personnel.

    abstract::Blood concentrations of nitrous oxide were measured in anaesthetists, surgeons and theatre nurses. Comparison of anaesthetists and surgeons working in the same theatre showed that in ENT surgeons concentrations were greater (P < 0.01), while in general surgeons they were smaller (P < 0.003). Blood concentrations of ni...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章

    doi:10.1093/bja/52.11.1143

    authors: Krapez JR,Saloojee Y,Hinds CJ,Hackett GH,Cole PV

    更新日期:1980-11-01 00:00:00

  • Dangers of anaesthesia in Munchausen's syndrome.

    abstract::Patients with Munchausen's syndrome often undergo multiple surgical operations under general anaesthesia. They tend to have multiple exposures to routinely used anaesthetic agents. A patient with Munchausen's syndrome who developed an anaphylactoid reaction to thiopentone is described and the importance of obtaining p...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章

    doi:10.1093/bja/59.11.1472

    authors: Frater RA,Lew JK

    更新日期:1987-11-01 00:00:00

  • Placental transfer of naloxone.

    abstract::Maternal and umbilical venous serum naloxone concentrations were measured after the i.v. (30 mothers) or i.m. (seven mothers) injection of naloxone 400 micrograms. Following i.v. naloxone there was rapid transfer to the fetus and therapeutic plasma concentrations could be expected in 1 or 2 min. However, following i.m...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章

    doi:10.1093/bja/58.1.45

    authors: Hibbard BM,Rosen M,Davies D

    更新日期:1986-01-01 00:00:00

  • Solvent for etomidate may cause pain and adverse effects.

    abstract::We tested the hypothesis that the solvent for etomidate was a factor in the incidence of pain and other side effects after injection, and that these were associated with histamine release. Nine of 10 volunteers who received etomidate in a propylene glycol formulation reported moderate to severe pain on injection; only...

    journal_title:British journal of anaesthesia

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1093/bja/83.3.464

    authors: Doenicke AW,Roizen MF,Hoernecke R,Lorenz W,Ostwald P

    更新日期:1999-09-01 00:00:00

  • Althesin as an induction agent for Caesarean section.

    abstract::Thirty patients for elective lower segment Caesarean section were randomly divided into two groups. One group received 50 mulitre/kg of Althesin for induction of anaesthesia and the other, 100 mulitre/kg. The two maternal groups were similar. There was no significant difference in the clinical or biochemical status of...

    journal_title:British journal of anaesthesia

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1093/bja/47.11.1213

    authors: Holdcroft A,Morgan M,Gordon H,Whitwam JG,White Y

    更新日期:1975-11-01 00:00:00

  • Tissue and corneal donation and transplantation in the UK.

    abstract::NHS Blood and Transplant (NHSBT) was established in 2005 as a Special Health Authority when the National Blood Authority and UK Transplant merged. This helped to bring tissue banking and organ transplantation services under one umbrella organization. This merger means that ~!95% of all deceased donors (whether tissue,...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章,评审

    doi:10.1093/bja/aer398

    authors: Gaum L,Reynolds I,Jones MN,Clarkson AJ,Gillan HL,Kaye SB

    更新日期:2012-01-01 00:00:00

  • Sevoflurane has less effect than halothane on pulmonary afferent activity in the rabbit.

    abstract::We have compared the effects of sevoflurane and halothane on the discharge frequencies of 19 slowly adapting and four rapidly adapting lung receptors in the rabbit by recording from single vagal fibres. Both agents reduced the discharge frequency of slowly adapting receptors during expiration (P < 0.0005), halothane h...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章

    doi:10.1093/bja/80.2.257

    authors: Moores C,Davies AS,Dallak M

    更新日期:1998-02-01 00:00:00

  • Arginine-vasopressin attenuates beneficial norepinephrine effect on jejunal mucosal tissue oxygenation during endotoxinaemia.

    abstract:BACKGROUND:The objective of the present study was to investigate the effects of increasing doses of norepinephrine (NE) with or without arginine-vasopressin (AVP) on intestinal oxygen supply and jejunal mucosal tissue oxygen tension in an acute endotoxic pig model. METHODS:In this prospective, randomized, experimental...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章

    doi:10.1093/bja/aep239

    authors: Maier S,Hasibeder W,Pajk W,Hengl C,Ulmer H,Hausdorfer H,Wurzinger B,Knotzer H

    更新日期:2009-11-01 00:00:00

  • Proportion of surgical patients with undiagnosed obstructive sleep apnoea.

    abstract:BACKGROUND:Obstructive sleep apnoea (OSA) affects ~9-24% of the general population, and 90% remain undiagnosed. Those patients with undiagnosed moderate-to-severe OSA may be associated with an increased risk of perioperative complications. Our objective was to evaluate the proportion of surgical patients with undiagnos...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章

    doi:10.1093/bja/aes465

    authors: Singh M,Liao P,Kobah S,Wijeysundera DN,Shapiro C,Chung F

    更新日期:2013-04-01 00:00:00

  • Pharmacology of an emulsion formulation of ICI 35 868.

    abstract::Studies with an emulsion formulation of ICI 35 868 (2,6- diisopropylphenol ) indicate that this new formulation has anaesthetic properties in rats and mice, and haemodynamic effects in the mini-pig which are similar to those of the previously available Cremophor formulation. Administration of the emulsion formulation ...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章

    doi:10.1093/bja/56.6.617

    authors: Glen JB,Hunter SC

    更新日期:1984-06-01 00:00:00

  • Differential effects of clonidine and dexmedetomidine on gastric emptying and gastrointestinal transit in the rat.

    abstract::We have studied the effect of clonidine, dexmedetomidine and morphine on gastric emptying and gastrointestinal transit in the rat. In one group, each agonist was injected i.p. in 6-12 male Wistar rats. In another group of rats, yohimbine, naloxone or saline was injected with an agonist. At 30 min, radiolabelled saline...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章

    doi:10.1093/bja/78.3.301

    authors: Asai T,Mapleson WW,Power I

    更新日期:1997-03-01 00:00:00

  • Value of a single preoperative PFA-100 measurement in assessing the risk of bleeding in patients taking cyclooxygenase inhibitors and undergoing total knee replacement.

    abstract:BACKGROUND:The usefulness of the PFA-100 in assessing the risk of bleeding in non-cardiac surgery is not clear. This study aims to examine this by correlating preoperative PFA-100 measurement with perioperative bleeding in patients receiving cyclooxygenase (COX) inhibitors. METHODS:PFA-100 with adenosine-5'-diphosphat...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章

    doi:10.1093/bja/aep091

    authors: Ng KF,Lawmin JC,Tsang SF,Tang WM,Chiu KY

    更新日期:2009-06-01 00:00:00

  • End-tidal carbon dioxide concentration as an indicator of pulmonary blood flow during closed heart surgery in children. A report of two cases.

    abstract::The value of the continuous monitoring of end-tidal carbon dioxide concentration as an indicator of the acute intraoperative interruption of pulmonary blood flow, in patients with pre-existing restrictions of pulmonary blood flow undergoing closed heart surgery, is illustrated by two case reports. Decreases in end-tid...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章

    doi:10.1093/bja/57.12.1257

    authors: Schuller JL,Bovill JG,Nijveld A

    更新日期:1985-12-01 00:00:00

  • Effect of heating on the osmotic fragility of stored blood.

    abstract::The effect of incubation at 37 degrees C, 46 degrees C, 47 degrees C and 48 degrees C for 1 h on the osmotic fragility of blood was determined. Blood taken from volunteers into ACD and CPD was examined after 1, 7, 14 and 21 days of storage. In addition, 22-day-old blood stored in CPD was examined. The osmotic fragilit...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章

    doi:10.1093/bja/50.8.815

    authors: Van der Walt JH,Russell WJ

    更新日期:1978-08-01 00:00:00

  • Naloxone improves functional recovery of myocardial stunning in conscious dogs through its action on the central nervous system.

    abstract::This study tests the hypothesis that naloxone, but not its quarternary salt, naloxone methiodide (which does not enter the central nervous system), improves recovery from myocardial stunning in conscious dogs. Twenty dogs were chronically instrumented for measurement of heart rate, left atrial, aortic and left ventric...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章

    doi:10.1093/bja/86.4.545

    authors: Weber TP,Stypmann J,Meissner A,Hartlage MG,Van Aken H,Rolf N

    更新日期:2001-04-01 00:00:00

  • Effects of sugammadex on incidence of postoperative residual neuromuscular blockade: a randomized, controlled study.

    abstract:BACKGROUND:This study aimed to investigate whether reversal of rocuronium-induced neuromuscular blockade with sugammadex reduced the incidence of residual blockade and facilitated operating room discharge readiness. METHODS:Adult patients undergoing abdominal surgery received rocuronium, followed by randomized allocat...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章,随机对照试验

    doi:10.1093/bja/aev104

    authors: Brueckmann B,Sasaki N,Grobara P,Li MK,Woo T,de Bie J,Maktabi M,Lee J,Kwo J,Pino R,Sabouri AS,McGovern F,Staehr-Rye AK,Eikermann M

    更新日期:2015-11-01 00:00:00

  • Does motor block related to long-acting brachial plexus block cause patient dissatisfaction after minor wrist and hand surgery? A randomized observer-blinded trial.

    abstract:BACKGROUND:Patient dissatisfaction has been previously associated with motor block in shoulder surgery patients receiving brachial plexus block. For elective minor wrist and hand surgery, we tested whether a regional block accelerating the early return of upper extremity motor function would improve patient satisfactio...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章,随机对照试验

    doi:10.1093/bja/aes266

    authors: Fredrickson MJ,Wolstencroft PJ,Chinchanwala S,Boland MR

    更新日期:2012-11-01 00:00:00

  • Post-tetanic count and single twitch height at the onset of reflex movement after administration of vecuronium under different types of anaesthesia.

    abstract::We have studied post-tetanic count (PTC) and single twitch height at the onset of reflex movement to carinal stimulation after administration of vecuronium with five different types of anaesthesia. Seventy-five adult patients were allocated randomly to five groups of 15 patients each, to receive one of the following a...

    journal_title:British journal of anaesthesia

    pub_type: 临床试验,杂志文章,随机对照试验,收录出版

    doi:10.1093/bja/72.6.688

    authors: Saitoh Y,Kaneda K,Toyooka H,Amaha K

    更新日期:1994-06-01 00:00:00

  • Extradural analgesia: the influence of volume and concentration of bupivacaine on the mode of delivery, analgesic efficacy and motor block.

    abstract::Five hundred and seventeen women in labour receiving extradural analgesia, using bupivacaine plain solution, were randomly allocated to one of three groups. Group A received 6-8ml of 0.5% solution, group B 10-14ml of 0.25% solution, and group C 6-8 ml of 0.25% solution. Spontaneous delivery occurred in 31.7% of patien...

    journal_title:British journal of anaesthesia

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1093/bja/53.9.933

    authors: Thorburn J,Moir DD

    更新日期:1981-09-01 00:00:00

  • Serum S100 protein as a marker of cerebral damage during cardiac surgery.

    abstract::The identification of a serum marker to assist in the diagnosis of cerebral injury after cardiac surgery is potentially useful. S100 protein is an early marker of cerebral damage. It is released after cardiac surgery performed under cardiopulmonary bypass (CPB). Its level is correlated with the duration of CPB, deep c...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章,评审

    doi:10.1093/bja/85.2.287

    authors: Ali MS,Harmer M,Vaughan R

    更新日期:2000-08-01 00:00:00

  • Low-dose ketamine affects immune responses in humans during the early postoperative period.

    abstract:BACKGROUND:Anaesthesia and surgery are associated with impairment of the immune system expressed as an excessive proinflammatory immune response and suppression of cell-mediated immunity that may affect the course of the postoperative period. Addition of anaesthetic agents capable of attenuating the alterations in peri...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章,随机对照试验

    doi:10.1093/bja/aem218

    authors: Beilin B,Rusabrov Y,Shapira Y,Roytblat L,Greemberg L,Yardeni IZ,Bessler H

    更新日期:2007-10-01 00:00:00

  • Four phases of intravenous fluid therapy: a conceptual model.

    abstract::I.V. fluid therapy plays a fundamental role in the management of hospitalized patients. While the correct use of i.v. fluids can be lifesaving, recent literature demonstrates that fluid therapy is not without risks. Indeed, the use of certain types and volumes of fluid can increase the risk of harm, and even death, in...

    journal_title:British journal of anaesthesia

    pub_type: 共识发展会议,杂志文章,评审

    doi:10.1093/bja/aeu300

    authors: Hoste EA,Maitland K,Brudney CS,Mehta R,Vincent JL,Yates D,Kellum JA,Mythen MG,Shaw AD,ADQI XII Investigators Group.

    更新日期:2014-11-01 00:00:00

  • Cardiac μ-opioid receptor contributes to opioid-induced cardioprotection in chronic heart failure.

    abstract:BACKGROUND:The therapeutic potential of cardiac μ-opioid receptors in ischaemia-reperfusion (I/R) injury during opioid-modulating diseases, such as heart failure, is unknown. We aimed to explore the changes of cardiac μ-opioid receptor expression during heart failure, and its role in opioid-induced cardioprotection. M...

    journal_title:British journal of anaesthesia

    pub_type: 杂志文章

    doi:10.1016/j.bja.2017.11.110

    authors: He SF,Jin SY,Yang W,Pan YL,Huang J,Zhang SJ,Zhang L,Zhang Y

    更新日期:2018-07-01 00:00:00

  • Spontaneous movements associated with rocuronium: is pain on injection the cause?

    abstract::Spontaneous movements are sometimes observed of the arm into which rocuronium is administered. In order to assess a possible relationship between these movements and pain, we injected in 10 awake, ASA I patients, in a double-blind manner, both rocuronium 1 ml (10 mg) and 0.9% NaCI 1 ml (placebo), with a 30-s interval ...

    journal_title:British journal of anaesthesia

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1093/bja/79.3.382

    authors: Borgeat A,Kwiatkowski D

    更新日期:1997-09-01 00:00:00