Department of Anaesthesia and Pain Management, Wellington Hospital, Wellington, New Zealand.
Medical Research Institute of New Zealand, Wellington, New Zealand.
Anaesth Intensive Care. 2023 May;51(3):185-192. doi: 10.1177/0310057X221131336. Epub 2023 Jan 31.
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) 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 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) or administering liberal perioperative oxygen therapy in line with the current WHO recommendation.
在澳大利亚和新西兰，麻醉师在术中给予氧气方面的做法尚未得到量化。目前还不知道全身麻醉下手术患者术中给予氧气的最佳方案，而且国际上关于氧气治疗的建议相互矛盾；世界卫生组织（WHO）建议术中吸入氧分数至少为 0.8，而世界麻醉医师学会、英国胸科学会和澳大利亚及新西兰胸科学会则建议采用更严格的方法。我们进行了一项前瞻性观察性研究，以描述澳大利亚和新西兰麻醉师术中给予氧气的模式；其次，确定按照 WHO 建议给予术中吸入氧气的麻醉师比例。我们从澳大利亚和新西兰的十家都市医院中确定了 150 名麻醉师，并观察了在全身麻醉下接受长时间手术的美国麻醉医师学会身体状况分类（ASA）3 或 4 级患者的术中氧气给予模式。所有研究参与者的术中时间加权平均吸入氧分数（FiO）中位数（四分位距）为 0.47（0.40-0.55）。150 名麻醉师中有 3 名（2%，95%置信区间 0.4 至 5.7）给予的平均术中 FiO 至少为 0.8。这些发现表明，在澳大利亚和新西兰，大多数麻醉师通常会为接受长时间手术的 ASA 3 或 4 级成年患者常规给予中等水平的氧气，而不是将吸入氧气降至目标脉搏血氧饱和度读数（SpO）或按照当前 WHO 建议给予宽松的围手术期氧气治疗。
