‘A wise man proportions his belief to the evidence’ (David Hume)

Abstract

© Anästh Intensivmed 2018. We comment on a biased review of Weiss and co-workers about the WHO recommendation to apply 80% oxygen intraoperatively in order to reduce surgical site infection (SSI), published in this journal. In addition, intraoperative hyperoxia in general is reviewed, as its beneficial effect on SSI is only one aspect proven for certain surgical groups only, such as patients with colorectal and major vascular surgery. It would be consequent recommending the application of pure oxygen (100%), most of all as it means maximal simplification of general anaesthesia thus resulting in significantly improving patients’ safety. Confusing different gases, such as oxygen and nitrous oxide with fatal consequences is impossible. In addition, the physiologic oxygen storage is optimized, and the lowest possible flow (150-300 ml/min) can be applied. Speculations that ventilating patients with high oxygen during surgery may be harmful, mainly based on experimental data or observations in ICU patients are opposed by numerous randomized clinical trials reporting beneficial effects of intraoperative hyperoxia on postoperative morbidity. Based on own published experience with 66,226 consecutive surgical patients we recommend intraoperative ventilation with 100% oxygen including adherence to essential adju-vant measures, such as consequent temperature management, optimized pain therapy incl. liberal application of regional continuous analgesia, antibiotic prophylaxis following the actual guidelines, low gas flow, restrictive use of relaxants incl. TOF monitoring and using short acting anaesthetics, such as propofol, desflurane and remifentanil.