Seventeen years ago, Anesthesiology News featured my opinion piece titled “Short-Term Oxygen: Not Enough of a Good Thing?” which emphasized the benefits of what I called “continual preoxygenation” ( may be required). It was interesting to see the similarly titled “Deliberate Oxygen Therapy – How Much Is Too Much of a Good Thing?” by Drs. Carness and Kuza in the June 2023 ASA Monitor (ASA Monitor 2023; 87:33). Without offering new evidence to the contrary, they suggest that we walk a theoretical fine line between barely enough and too much oxygen during the brief peri-anesthetic period. They state, “Our patients seemingly tolerate the administration of supratherapeutic oxygen levels.” As emphasized in my column, “Would it not be prudent to provide the patient with continual preoxygenation before the sudden onset of airway loss, a low perfusion state or undiagnosed end-organ hypoperfusion?” Until such time as definitive evidence exists of an adverse consequence of short-term hyperoxia, it remains acceptable practice to keep patients ready to tolerate a prolonged unanticipated period of inadequate oxygenation.

Stephen London, MD

Medical Director

Aloha Surgical Center

Maui, Hawaii