Intended for healthcare professionals


Oxygen administration during general anaesthesia for surgery

BMJ 2022; 379 doi: (Published 30 November 2022) Cite this as: BMJ 2022;379:o2823

Linked Research

Oxygen administration during surgery and postoperative organ injury

Linked Opinion

Perioperative oxygen administration: finding the sweet spot

  1. Michele Samaja, professor1 2,
  2. Davide Chiumello, professor2 3
  1. 1MAGI Group, San Felice del Benaco, Brescia, Italy
  2. 2Department of Health Science, University of Milan, Milan, Italy
  3. 3Department of Anaesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Italy
  1. Correspondence to: M Samaja michele.samaja{at}

Oxygen can be a double edged sword

Oxygen is routinely administered to almost all patients undergoing general anaesthesia,1 to ensure adequate oxygenation from intubation until awakening—the period when complications due to hypoxaemia are most likely to occur.2 Currently, the optimal target for oxygen administration is not yet clear and varies from normal arterial oxygen saturation to hyperoxaemia (usually defined as >97-98% arterial oxygen saturation). The hyperoxaemia strategy has been widely used since a seminal study highlighted the benefits of liberal (80%) compared with restrictive (30-35%) inspired oxygen to reduce the risk of postoperative infection.3 Accordingly, the 2016 World Health Organization guidelines recommend that patients receive a liberal fraction of inspired oxygen during general anaesthesia and in the immediate postoperative period.45

Basic research, however, shows that oxygen can be a double edged sword.6 It is a fundamental substrate for the oxidative phosphorylation that feeds biological energy to every aerobic cell. But in certain circumstances, oxygen may give rise to highly reactive …

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