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| Content Provider | World Health Organization (WHO)-Global Index Medicus |
|---|---|
| Author | Kurz, A. Fleischmann, E. Sessler, D. I. Buggy, D. J. Apfel, C. Akça, O. |
| Description | Country affiliation: United States Author Affiliation: Kurz A ( Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.); Fleischmann E ( Department of Anaesthesia, Medical University of Vienna, Vienna Medical University, Vienna, Austria.); Sessler DI ( Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA ds@or.org.); Buggy DJ ( School of Medicine and Medical Science, University College Dublin and Mater Misericordiae University Hospital, Dublin, Ireland.); Apfel C ( Sagemedic, Inc., Larkspur, CA, USA.); Akça O ( Department of Anaesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, USA.) |
| Abstract | BACKGROUND: Tissue oxygenation is a strong predictor of surgical site infection. Improving tissue oxygenation should thus reduce wound infection risk. Supplemental inspired oxygen can improve tissue oxygenation, but whether it reduces infection risk remains controversial. Low-dose dexamethasone is often given to reduce the risk of postoperative nausea and vomiting, but steroid-induced immunosuppression can increase infection risk. We therefore tested the hypotheses that supplemental perioperative oxygen reduces infection risk and that dexamethasone increases it. METHODS: Using a factorial design, patients having colorectal resections expected to last ≥2 h were randomly assigned to 30% (n=270) or 80% (n=285) inspired oxygen during and for 1 h after surgery, and to 4 mg intraoperative dexamethasone (n=283) or placebo (n=272). Physicians blinded to group assignments evaluated wounds postoperatively, using US Centers for Disease Control criteria. RESULTS: Subject and surgical characteristics were similar among study groups. Surgical site infection incidence was similar among groups: 30% oxygen 15.6%, 80% oxygen 15.8% (P=1.00); dexamethasone 15.9%, placebo 15.4%, (P=0.91). CONCLUSIONS: Supplemental oxygen did not reduce surgical site infection risk. The preponderance of clinical evidence suggests that administration of 80% supplemental inspired oxygen does not reduce infection risk. We did not observe an increased risk of surgical site infection with the use of a single low dose of dexamethasone, indicating that it can be used for nausea and vomiting prophylaxis without promoting wound infections. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov number: NCT00273377. |
| File Format | HTM / HTML |
| ISSN | 00070912 |
| e-ISSN | 14716771 |
| Journal | British Journal of Anaesthesia |
| Issue Number | 3 |
| Volume Number | 115 |
| Language | English |
| Publisher | Oxford University Press |
| Publisher Date | 2015-09-01 |
| Publisher Place | Great Britain (UK) |
| Access Restriction | Open |
| Subject Keyword | Discipline Anesthesiology Antiemetics Administration & Dosage Dexamethasone Oxygen Postoperative Complications Epidemiology Surgical Wound Infection Colorectal Surgery Multicenter Study Randomized Controlled Trial |
| Content Type | Text |
| Resource Type | Article |
| Subject | Anesthesiology and Pain Medicine |
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