Avoidance of Nitrous Oxide for Patients Undergoing Major Surgery (original) (raw)
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Anaesthesia, 2010
Some, but not all studies have suggested intra-operative use of nitrous oxide is correlated with postoperative nausea and vomiting. We performed a meta-analysis of randomised controlled trials to compare the incidence of nausea and vomiting in adults following general anaesthesia with or without nitrous oxide. We retrieved 30 studies (incorporating 33 separate trials) that investigated a ‘nitrous oxide group’ (total 2297 patients) vs a ‘no-nitrous oxide group’ (2301 patients). Omitting nitrous oxide significantly reduced postoperative nausea and vomiting (pooled relative risk 0.80, 95% CI 0.71–0.90, p = 0.0003). However, the absolute incidence of nausea and vomiting was high in both the nitrous oxide and no-nitrous oxide groups (33% vs 27%, respectively). In subgroup analysis, the maximal risk reduction was obtained in female patients (pooled relative risk 0.76, 95% CI 0.60–0.96). When nitrous oxide was used in combination with propofol, the antiemetic effect of the latter appeared to compensate the emetogenic effect of nitrous oxide (pooled relative risk 0.94, 95% CI 0.77–1.15). We conclude that avoiding nitrous oxide does reduce the risk of postoperative nausea and vomiting, especially in women, but the overall impact is modest.
Anesthesiology, 2016
The Evaluation of Nitrous oxide in the Gas Mixture for Anesthesia II trial randomly assigned 7,112 noncardiac surgery patients to a nitrous oxide or nitrous oxide-free anesthetic; severe postoperative nausea and vomiting (PONV) was a prespecified secondary end point. Thus, the authors evaluated the association between nitrous oxide, severe PONV, and effectiveness of PONV prophylaxis in this setting. Univariate and multivariate analyses of patient, surgical, and other perioperative characteristics were used to identify the risk factors for severe PONV and to measure the impact of severe PONV on patient outcomes. Avoiding nitrous oxide reduced the risk of severe PONV (11 vs. 15%; risk ratio [RR], 0.74 [95% CI, 0.63 to 0.84]; P < 0.001), with a stronger effect in Asian patients (RR, 0.55 [95% CI, 0.43 to 0.69]; interaction P = 0.004) but lower effect in those who received PONV prophylaxis (RR, 0.89 [95% CI, 0.76 to 1.05]; P = 0.18). Gastrointestinal surgery was associated with an in...
Is nitrous oxide necessary for general anaesthesia?
J Ayub Med Coll Abbottabad, 2008
Background Nitrous oxide (N 2 O) has been used for about 150 years in clinical anaesthesia. Several recent reviews of the effect of nitrous oxide have concluded that there are certain contraindications to the use of this gas for general anaesthesia and its ecological effects, ozone depleting potential, immune depression and the proven factor of PONV have questioned the routine use of nitrous oxide in patients undergoing surgical procedures in general anaesthesia. Methods: This study comprised of 200 adult patients undergoing general anaesthesia with 40% O 2 and Sevoflurane with and without N 2 O. All patients had standard anaesthetic care and monitoring with BIS monitoring in 120 patients. The effect of avoiding N 2 O was observed on anaesthetic perioperative management and haemodynamics, PONV and pain in PACU. Results: Demographic and perioperative characteristics were similar to both groups. Nitrous oxide free group needed only 0.233% (mean) more Sevoflurane. There was a marked reduction in incidence of PONV (11% to5 %) in N 2 O free group. Duration of surgery (97.72±52.393 in N 2 O group, 103.75±48.671 in N 2 O free group) and induction dose of propofol (155.30 ±38.572 in N 2 O group and 158.50± 36.164 in N 2 O free group) did not differ significantly in the two groups. Conclusion: The omitting of N 2 O from anaesthetic regimen has a substantial impact on patient comfort after surgery by reducing incidence of PONV and it does not have any justifiable indication of its use in General anaesthesia.
Nitrous oxide does not influence operating conditions or postoperative course in colonic surgery
BJA: British Journal of Anaesthesia, 1994
We studied 150 patients undergoing elective colonic surgery; they were allocated randomly to undergo artificial ventilation with either air-oxygen or nitrous oxide-oxygen during surgery. Eleven patients were excluded. Preoperative management, surgery and postoperative analgesia were similar in both groups. Anaesthesia included propofol by infusion, pancuronium and fentanyl 3 fig kg~1 h~'. The air-oxygen group required a continuous infusion of propofol of 4-6 mg kg~' h~1 whereas the nitrous oxide-oxygen group required only 1-2 mg kg~' h~'. There were no differences between the groups in duration of anaesthesia, distension of the bowel and postoperative bowel function. The postoperative hospital stay was similar for both groups. (Br.