Impact of a high inspired oxygen fraction on oxidative stress in pediatric patients: reassuring results based on a randomized trial

Ting Li, Ying Han, Xiaodie Zhang, Jialian Zhao, Yaojun Suo, Yaoqin Hu

¹Department of Anesthesiology, Shaoxing Maternity and Child Health Care Hospital, Maternity and Child Health Care Affiliated Hospital, Shaoxing University, Shaoxing, Zhejiang Province, China²Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China³Department of Anesthesiology, Children’s Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China

Abstract

High-concentration oxygen inhalation is the primary intervention to prevent perioperative hypoxemia. However, there are concerns that this may induce an imbalance in oxidation‒reduction processes, particularly in pediatric patients with compromised antioxidant defenses. This study aimed to evaluate the impact of varying intraoperative concentrations of oxygen inhalation on oxidative stress in children by analyzing plasma biomarkers, oxygenation indices, and the duration of surgery and oxygen inhalation. Forty-five children scheduled for laparoscopic pyeloplasty under general anesthesia were randomly assigned to three groups, each receiving different fractions of inspired oxygen during surgery: 30%, 50%, or 80%. The primary outcome was the plasma concentration of oxidative stress markers, and the other measurements included the surgical duration and duration of oxygen exposure. Thirty-five children completed the study, with 11 in the low group, 12 in the medium group and 12 in the high group. The levels of superoxide dismutase at immediately post-tracheal intubation, hydrogen peroxide at 1 hour post-intubation, and 8-isoprostane at immediately post-surgical procedure were significantly higher in the high group than in the low group. The S100B levels at immediately post-surgical procedure were higher than those at immediately post-tracheal intubation and 1 hour post-intubation within the low group. Therefore, we conclude that inhaling a high concentration of oxygen during laparoscopic pyeloplasty under general anesthesia, for a duration of less than 3 hours, does not significantly increase oxidative stress in pediatric patients. This study was registered at the Chinese Clinical Trial Registry (registration No. ChiCTR2400083143).

摘要：高浓度吸氧是预防围手术期低氧血症的主要干预措施。然而，人们担心这可能会导致氧化还原过程的不平衡，特别是在抗氧化防御受损的儿科患者中。本研究旨在通过分析血浆生物标志物、氧合指标、手术时间和吸氧时间，评估术中不同吸氧浓度对儿童氧化应激的影响。45名在全身麻醉下计划进行腹腔镜肾盂成形术的儿童随机分为三组，每组在手术中接受不同比例的吸氧：30%，50%或80%。主要结果是血浆中氧化应激标志物的浓度，其他测量包括手术时间和氧暴露时间。35名儿童完成了这项研究，其中11名在低水平组，12名在中等水平组，12名在高水平组。气管插管后立即超氧化物歧化酶水平，插管后1小时过氧化氢水平，术后立即8-异前列腺素水平，高组明显高于低组。低剂量组术后即刻S100B水平高于气管插管后即刻和插管后1小时。因此，我们得出结论，在腹腔镜肾盂成形术中，在全身麻醉下吸入高浓度氧气，持续时间小于3小时，不会显著增加儿科患者的氧化应激。本研究已在中国临床试验注册中心注册(注册号：ChiCTR2400083143)。