Abstract: Objective  To investigate the correlation between perioperative oxygen concentration and postoperative organ injury and other adverse reactions in children undergoing neurosurgery. Methods  This study is a single-center retrospective cohort study, including 512 children aged ≤14 years and operating duration ≥2 hours who were transferred after surgery to postanesthesia care unit (PACU), Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University from October 2018 to September 2023. His electronic medical record system was used to review and collect the patient's medical records during hospitalization. Including baseline data, anesthetic use, duration of anesthesia, intraoperative oxygen concentration, postoperative diagnosis, and surgical method; blood pressure, heart rate, oxygen saturation, pain score and special conditions during anesthesia recovery; infection during postoperative hospitalization (including wound infection, intracranial infection), respiratory complications ［confirmed by chest radiograph/chest computed tomography (CT) report］, changes in renal function (first postoperative serum creatinine value - last preoperative serum creatinine value), and incidence of delirium during recovery period during anesthesia were recorded. The area under oxygen concentration-time curve area under curve AUCFiO₂=the product of intraoperative oxygen concentration (%) and duration of anesthesia (min) was calculated, and then 512 children were divided into 3 groups according to the AUCFiO₂ tripartite (group 1:AUCFiO₂<8 720%min, group 2: 8 720%·min≤AUCFiO₂≤13 800%·min, group 3: AUCFiO₂ > 13 800%·min) were included in the data analysis. Results  The incidence of emergency delirium (ED)during postoperative recovery was 24%, 26. 9% and 19. 4%, and the incidence of acute kidney injury(AKI) was 0. 6%, 2. 3% and 0. 6%, respectively. There was no significant difference between the three groups (P > 0. 05). The incidence of postoperative pulmonary complications in the three groups was 20. 6%, 20. 8% and 31. 5%, respectively, and there was significant statistical difference among the three groups (P<0. 05). There were no significant differences in nausea, vomiting, hypoxemia, and PACU residence time among the three groups during anesthesia recovery room (P > 0. 05), and there were significant differences in intracranial infection, wound infection and hospital stay during hospitalization (P<0. 05). Conclusion  Although oxygen concentration AUCFiO₂ has no correlation with the occurrence of postoperative AKI and ED, the longer the exposure time of conventional oxygen administration strategy, the higher the incidence of postoperative pulmonary complications and postoperative infection, and the longer the hospitalization time of children.

Key words: neurosurgery, oxygen concentration, emergency delirium, acute kidney injury, pulmonary complications, children