Rethinking perioperative oxygen therapy

Oxygen administration is foundational in anesthesiology and perioperative medicine, yet growing evidence challenges the routine use of high inspired oxygen concentrations. While preventing hypoxia remains essential during induction, emergence, and perioperative urgencies, both hypoxia and hyperoxia carry significant risks—including inflammation, oxidative stress, vasoconstriction, and impaired organ perfusion. These effects are especially pronounced in high-risk surgical patients. Recent advances in noninvasive hemodynamic and oxygenation monitoring now allow dynamic, individualized titration of oxygen delivery (DO2), moving beyond conventional SpO2 targets. Guidelines from cardiovascular societies increasingly support focused oxygenation goals during perioperative cardiac and cerebro-vascular emergencies. In the context of perioperative complexity and management of high-risk patients, anesthesiologists are uniquely positioned to lead a shift toward goal-directed oxygen therapy. Recognizing oxygen as a dose-dependent drug offers an opportunity to optimize outcomes through a nuanced, physiology-informed approach to intraoperative and perioperative care.