Progress of Perioperative Oxidative Stress in Children

Abstract

Oxidative stress occurs when the accumulation of oxidants exceeds the bodys antioxidant defenses. Reactive oxygen species (ROS) are the primary oxidants and their generation is influenced by various factors including disease states, surgical procedures, and anesthetics. Studies have shown that various perioperative complications are attributed to ROS, especially in immature organs and systems. The pediatric oxidative stress profile is distinct from that seen in adults. We conducted a search for publicly available studies on perioperative oxidative stress, including both reviews and original research articles, animal studies, and clinical trials. In this review, we provide an overview of the factors that influence oxidative stress, the impact of perioperative oxidative stress on the body, and the biomarkers and measurement methods for oxidative stress. We also summarize current knowledge of oxidative stress in children during the perioperative period. Emphasis was placed on various factors during the perioperative period that affect oxidative stress in children including specific surgical procedures, anesthetic agents and their use, fluid therapy, mechanical ventilation, and oxygen inhalation. This review also provides several insights into oxidative stress in children during the perioperative period. Current evidence indicates that the greater the surgical trauma, the stronger the oxidative stress response, and this is due to ischemia-reperfusion injury which is particularly evident in pediatric cardiac surgery. Regional anesthesia is helpful in reducing systemic oxidative stress levels compared to general anesthesia. Intravenous anesthetics have an inhibitory effect on the build-up of oxidative stress when compared to inhaled anesthetics. Further, compared with unrestrictive fluid therapy, restrictive fluid therapy, during the perioperative period, can enhance the bodys antioxidant capacity. In addition, we found that mechanical ventilation also increases oxidative stress. Therefore, to minimize perioperative oxidative stress, children undergoing surgery should, whenever possible, be treated with minimally invasive techniques such as laparoscopy and arthroscopy. Children undergoing general anesthesia should be given intravenous anesthetics if possible. A restrictive fluid therapy strategy should be adopted, and mechanical ventilation should be avoided. Finally, during perioperative treatment, exogenous antioxidants could be included.