Article information
Resumen
Objetivo
Evaluar la efectividad y la seguridad del suministro de oxigeno (fraccion inspirada de oxigeno, FiO2) en concentraciones altas comparado con concentraciones bajas, para poder disminuir complicaciones en pacientes sometidos a procedimientos quirurgicos bajo anestesia general.
MétodosSe realizaron una revision sistematica y un meta-analisis siguiendo la metodologia propuesta por la Colaboracion Cochrane. Se incluyeron experimentos clinicos controlados llevados a cabo en pacientes adultos sometidos a procedimientos quirurgicos bajo anestesia general. Se hizo una busqueda en bases de datos (PUBMED, CENTRAL y LILACS) y, con los estudios pertinentes identificados, se complemento con una nueva busqueda ambispectiva en bola de nieve y en fuentes de literatura gris.
ResultadosSe incluyeron 17 experimentos clinicos (4.844 pacientes), de los cuales siete fueron considerados de bajo riesgo de sesgo. Las FiO2 altas disminuyen la nausea y el vomito posoperatorio solo en cirugias de manipulacion intestinal extensa (odds ratio [OR] 0,40; intervalo de confianza [IC] 95%, 0,20 a 0,80). En este mismo escenario clinico, tambien disminuyen el riesgo de infeccion del sitio operatorio (OR 0,46; IC 95%, 0,29 a 0,74) y la mortalidad (OR 0,17; IC 95%, 0,03 a 0,99). La necesidad de antiemetico de rescate, tiempo de estancia en la unidad de cuidado postanestesico, admision no esperada a la unidad de cuidados intensivos y tiempo de estancia hospitalaria posoperatoria no se afectan en ningun tipo de poblacion quirurgica.
ConclusionesEl oxigeno suplementario intraoperatorio en concentraciones altas (≥60%) podria disminuir el riesgo de infeccion del sitio operatorio y la mortalidad en cirugias en las que se produce manipulacion intestinal extensa
Palabras clave:
Anestesia General
Efectividad
Seguridad
Morbilidad
Abstract
Objective
To evaluate the effectiveness and safety of oxygen supplementation (inspired fraction of oxygen, FiO2) in high concentrations versus low concentrations, given with the aim of reducing complications in patients undergoing surgical procedures under general anesthesia.
MethodsA systematic review and a meta-analysis were performed following the methodology proposed by the Cochrane Collaboration. The review included controlled clinical trials conducted in patients undergoing surgical procedures under general anesthesia. After conducting data base searches (PUBMED, CENTRAL y LILACS), and once the relevant studies were identified, additional snowballing ambispective and grey literature searches were done.
ResultsOf the 17 clinical trials finally included (4844 patients), 7 were considered to a have a low risk of bias. High FiO2 levels reduce post-operative nausea and vomiting only in surgeries with extensive intestinal manipulation (odds ratio [OR] 0.40; 95% confidence interval [CI], 0.20 to 0.80). In this same clinical setting, the risk of surgical site infection (OR 0.46; 95% CI, 0.29 to 0.74), and mortality (OR 0.17; 95% CI, 0.03 to 0.99) are also reduced. There was no impact on the need for rescue anti-emetic administration, length of stay in the post-anesthetic care unit, unexpected admission to the intensive care unit, or postoperative hospital stay in any of the surgical populations.
ConclusionsIntra-operative oxygen supplementation in high concentrations (≥60%) might reduce the risk of surgical site infection and mortality in surgeries with extensive intestinal manipulation.
Keywords:
General anesthesia
Effectiveness
Safety
Morbidity
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