ORCID Profile
0000-0003-0621-5160
Current Organisations
University of Otago
,
Medical Research Institute of New Zealand
,
Wellington Hospital
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Publisher: SAGE Publications
Date: 31-01-2023
DOI: 10.1177/0310057X221131336
Abstract: 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 2 ) 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 2 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 2 ) or administering liberal perioperative oxygen therapy in line with the current WHO recommendation.
Publisher: SAGE Publications
Date: 05-2019
Abstract: We conducted a survey of Australian and New Zealand anaesthetists to determine self-reported practice of perioperative oxygen administration and to quantify perceptions regarding the perceived benefits and risks resulting from liberal oxygen therapy delivered in a manner consistent with the current World Health Organization guidelines. In addition, we sought feedback on the acceptability of several proposed clinical trial designs aiming to assess the overall effect of liberal and restricted perioperative oxygen regimens on patient outcomes. We developed a 23-question electronic survey that was emailed to 972 randomly selected Australian and New Zealand College of Anaesthetists (ANZCA) Fellows. We received responses from 282 of 972 invitees (response rate 29%). The majority of survey participants indicated that they routinely titrate inspired oxygen to a level they feel is safe (164/282, 58%) or minimise oxygen administration (82/282, 29%), while 5% of respondents indicated that they aim to maximise oxygen administration. The mean value for targeted intraoperative fraction inspired oxygen (FiO 2 ) was 0.41 (standard deviation 0.12). Of the survey respondents, 2/282 (0.7%) indicated they believe that routine intra- and postoperative administration of ≥80% oxygen reduces the risk of surgical site infection. Well-designed and conducted randomised trials on this topic may help to better direct clinicians' choices. A high level of willingness to participate (80% of responses) in a study designed to investigate the impact of differing approaches to perioperative oxygen administration suggests that recruitment is likely to be feasible in a future study.
Publisher: Elsevier BV
Date: 12-2020
Publisher: Wiley
Date: 02-08-2023
DOI: 10.1111/ANAE.16103
Abstract: International recommendations encourage liberal administration of oxygen to patients having surgery under general anaesthesia, ostensibly to reduce surgical site infection. However, the optimal oxygen regimen to minimise postoperative complications and enhance recovery from surgery remains uncertain. The hospital operating theatre randomised oxygen (HOT‐ROX) trial is a multicentre, patient‐ and assessor‐blinded, parallel‐group, randomised clinical trial designed to assess the effect of a restricted, standard care, or liberal peri‐operative oxygen therapy regimen on days alive and at home after surgery in adults undergoing prolonged non‐cardiac surgery under general anaesthesia. Here, we report the findings of the internal vanguard feasibility phase of the trial undertaken in four large metropolitan hospitals in Australia and New Zealand that included the first 210 patients of a planned overall 2640 trial s le, with eight pre‐specified endpoints evaluating protocol implementation and safety. We screened a total of 956 participants between 1 September 2019 and 26 January 2021, with data from 210 participants included in the analysis. Median (IQR [range]) time‐weighted average intra‐operative F i O 2 was 0.30 (0.26–0.35 [0.20–0.59]) and 0.47 (0.44–0.51 [0.37–0.68]) for restricted and standard care, respectively (mean difference (95%CI) 0.17 (0.14–0.20), p 0.001). Median time‐weighted average intra‐operative F i O 2 was 0.83 (0.80–0.85 [0.70–0.91]) for liberal oxygen therapy (mean difference (95%CI) compared with standard care 0.36 (0.33–0.39), p 0.001). All feasibility endpoints were met. There were no significant patient adverse events. These data support the feasibility of proceeding with the HOT‐ROX trial without major protocol modifications.
No related grants have been discovered for Daniel Frei.