Oxygenation during general anesthesia in pediatric patients: A retrospective observational study

Study objective: Protocols are used in intensive care and emergency settings to limit the use of oxygen. However, in pediatric anesthesiology, such protocols do not exist. This study aimed to investigate the administration of oxygen during pediatric general anesthesia and related these values to PaO2, SpO(2) and SaO(2). Design: Retrospective observational study. Setting: Tertiary pediatric academic hospital, from June 2017 to August 2020. Patients: Patients aged 0-18 years who underwent general anesthesia for a diagnostic or surgical procedure with tracheal intubation and an arterial catheter for regular blood withdrawal were included. Patients on cardiopulmonary bypass or those with missing data were excluded. Electronic charts were reviewed for patient characteristics, type of surgery, arterial blood gas analyses, and oxygenation management. Interventions: No interventions were done. Measurements: Primary outcome defined as FiO(2), PaO2 and SpO(2) values were interpreted using descriptive analyses, and the correlation between PaO2 and FiO(2) was determined using the weighted Spearman correlation coefficient. Main results: Data of 493 cases were obtained. Of these, 267 were excluded for various reasons. Finally, 226 cases with a total of 645 samples were analyzed. The median FiO(2) was 36% (IQR 31 to 43), with a range from 20% to 97%, and the median PaO2 was 23.6 kPa (IQR 18.6 to 28.1); 177 mmHg (IQR 140 to 211). The median SpO(2) level was 99% (IQR 98 to 100%). The study showed a moderately positive association between PaO2 and FiO(2) (r = 0.52, p < 0.001). 574 of 645 samples (89%) contained a PaO2 higher than 13.3 kPa; 100 mmHg. Conclusions: Oxygen administration during general pediatric anesthesia is barely regulated. Hyperoxemia is observed intraoperatively in approximately 90% of cases. Future research should focus on outcomes related to hyperoxemia.