Avoidance of nitrous oxide for patients undergoing major surgery : A randomized controlled trial
Nitrous oxide is widely used in anesthesia, often administered at an inspired concentration around 70%. Although nitrous oxide interferes with vitamin B12, folate metabolism, and deoxyribonucleic acid synthesis and prevents the use of high inspired oxygen concentrations, the consequences of these ef...
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| Veröffentlicht in: | Anesthesiology (Philadelphia) 2007-08, Vol.107 (2), p.221-231 |
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| creator | MYLES, Paul S LESLIE, Kate CHAN, Matthew T. V FORBES, Andrew PAECH, Michael J PEYTON, Philip SILBERT, Brendan S PASCOE, Elaine |
| description | Nitrous oxide is widely used in anesthesia, often administered at an inspired concentration around 70%. Although nitrous oxide interferes with vitamin B12, folate metabolism, and deoxyribonucleic acid synthesis and prevents the use of high inspired oxygen concentrations, the consequences of these effects are unclear.
Patients having major surgery expected to last at least 2 h were randomly assigned to nitrous oxide-free (80% oxygen, 20% nitrogen) or nitrous oxide-based (70% N2O, 30% oxygen) anesthesia. Patients and observers were blind to group identity. The primary endpoint was duration of hospital stay. Secondary endpoints included duration of intensive care stay and postoperative complications; the latter included severe nausea and vomiting, and the following major complications: pneumonia, pneumothorax, pulmonary embolism, wound infection, myocardial infarction, venous thromboembolism, stroke, awareness, and death within 30 days of surgery.
Of 3,187 eligible patients, 2,050 consenting patients were recruited. Patients in the nitrous oxide-free group had significantly lower rates of major complications (odds ratio, 0.71; 95% confidence interval, 0.56-0.89; P = 0.003) and severe nausea and vomiting (odds ratio, 0.40; 95% confidence interval, 0.31-0.51; P < 0.001), but median duration of hospital stay did not differ substantially between groups (7.0 vs. 7.1 days; P = 0.06). Among patients admitted to the intensive care unit postoperatively, those in the nitrous oxide-free group were more likely to be discharged from the unit on any given day than those in the nitrous oxide group (hazard ratio, 1.35; 95% confidence interval, 1.05-1.73; P = 0.02).
Avoidance of nitrous oxide and the concomitant increase in inspired oxygen concentration decreases the incidence of complications after major surgery, but does not significantly affect the duration of hospital stay. The routine use of nitrous oxide in patients undergoing major surgery should be questioned. |
| doi_str_mv | 10.1097/01.anes.0000270723.30772.da |
| format | Article |
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Patients having major surgery expected to last at least 2 h were randomly assigned to nitrous oxide-free (80% oxygen, 20% nitrogen) or nitrous oxide-based (70% N2O, 30% oxygen) anesthesia. Patients and observers were blind to group identity. The primary endpoint was duration of hospital stay. Secondary endpoints included duration of intensive care stay and postoperative complications; the latter included severe nausea and vomiting, and the following major complications: pneumonia, pneumothorax, pulmonary embolism, wound infection, myocardial infarction, venous thromboembolism, stroke, awareness, and death within 30 days of surgery.
Of 3,187 eligible patients, 2,050 consenting patients were recruited. Patients in the nitrous oxide-free group had significantly lower rates of major complications (odds ratio, 0.71; 95% confidence interval, 0.56-0.89; P = 0.003) and severe nausea and vomiting (odds ratio, 0.40; 95% confidence interval, 0.31-0.51; P < 0.001), but median duration of hospital stay did not differ substantially between groups (7.0 vs. 7.1 days; P = 0.06). Among patients admitted to the intensive care unit postoperatively, those in the nitrous oxide-free group were more likely to be discharged from the unit on any given day than those in the nitrous oxide group (hazard ratio, 1.35; 95% confidence interval, 1.05-1.73; P = 0.02).
Avoidance of nitrous oxide and the concomitant increase in inspired oxygen concentration decreases the incidence of complications after major surgery, but does not significantly affect the duration of hospital stay. The routine use of nitrous oxide in patients undergoing major surgery should be questioned.</description><identifier>ISSN: 0003-3022</identifier><identifier>EISSN: 1528-1175</identifier><identifier>DOI: 10.1097/01.anes.0000270723.30772.da</identifier><identifier>PMID: 17667565</identifier><identifier>CODEN: ANESAV</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott</publisher><subject><![CDATA[Adolescent ; Adult ; Anesthesia ; Anesthesia Recovery Period ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Anesthetics, Inhalation - administration & dosage ; Anesthetics, Inhalation - adverse effects ; Anesthetics, Inhalation - therapeutic use ; Biological and medical sciences ; Female ; Folic Acid - administration & dosage ; Humans ; Kaplan-Meier Estimate ; Length of Stay - statistics & numerical data ; Male ; Medical sciences ; Nitrogen - administration & dosage ; Nitrous Oxide - adverse effects ; Nitrous Oxide - therapeutic use ; Odds Ratio ; Oxygen - administration & dosage ; Postoperative Complications - chemically induced ; Postoperative Nausea and Vomiting - chemically induced ; Risk ; Surgical Procedures, Operative ; Treatment Outcome ; Vitamin B Complex - administration & dosage]]></subject><ispartof>Anesthesiology (Philadelphia), 2007-08, Vol.107 (2), p.221-231</ispartof><rights>2007 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18955951$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17667565$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>MYLES, Paul S</creatorcontrib><creatorcontrib>LESLIE, Kate</creatorcontrib><creatorcontrib>CHAN, Matthew T. V</creatorcontrib><creatorcontrib>FORBES, Andrew</creatorcontrib><creatorcontrib>PAECH, Michael J</creatorcontrib><creatorcontrib>PEYTON, Philip</creatorcontrib><creatorcontrib>SILBERT, Brendan S</creatorcontrib><creatorcontrib>PASCOE, Elaine</creatorcontrib><creatorcontrib>ENIGMA Trial Group</creatorcontrib><title>Avoidance of nitrous oxide for patients undergoing major surgery : A randomized controlled trial</title><title>Anesthesiology (Philadelphia)</title><addtitle>Anesthesiology</addtitle><description>Nitrous oxide is widely used in anesthesia, often administered at an inspired concentration around 70%. Although nitrous oxide interferes with vitamin B12, folate metabolism, and deoxyribonucleic acid synthesis and prevents the use of high inspired oxygen concentrations, the consequences of these effects are unclear.
Patients having major surgery expected to last at least 2 h were randomly assigned to nitrous oxide-free (80% oxygen, 20% nitrogen) or nitrous oxide-based (70% N2O, 30% oxygen) anesthesia. Patients and observers were blind to group identity. The primary endpoint was duration of hospital stay. Secondary endpoints included duration of intensive care stay and postoperative complications; the latter included severe nausea and vomiting, and the following major complications: pneumonia, pneumothorax, pulmonary embolism, wound infection, myocardial infarction, venous thromboembolism, stroke, awareness, and death within 30 days of surgery.
Of 3,187 eligible patients, 2,050 consenting patients were recruited. Patients in the nitrous oxide-free group had significantly lower rates of major complications (odds ratio, 0.71; 95% confidence interval, 0.56-0.89; P = 0.003) and severe nausea and vomiting (odds ratio, 0.40; 95% confidence interval, 0.31-0.51; P < 0.001), but median duration of hospital stay did not differ substantially between groups (7.0 vs. 7.1 days; P = 0.06). Among patients admitted to the intensive care unit postoperatively, those in the nitrous oxide-free group were more likely to be discharged from the unit on any given day than those in the nitrous oxide group (hazard ratio, 1.35; 95% confidence interval, 1.05-1.73; P = 0.02).
Avoidance of nitrous oxide and the concomitant increase in inspired oxygen concentration decreases the incidence of complications after major surgery, but does not significantly affect the duration of hospital stay. The routine use of nitrous oxide in patients undergoing major surgery should be questioned.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Anesthesia</subject><subject>Anesthesia Recovery Period</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Anesthetics, Inhalation - administration & dosage</subject><subject>Anesthetics, Inhalation - adverse effects</subject><subject>Anesthetics, Inhalation - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Female</subject><subject>Folic Acid - administration & dosage</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Nitrogen - administration & dosage</subject><subject>Nitrous Oxide - adverse effects</subject><subject>Nitrous Oxide - therapeutic use</subject><subject>Odds Ratio</subject><subject>Oxygen - administration & dosage</subject><subject>Postoperative Complications - chemically induced</subject><subject>Postoperative Nausea and Vomiting - chemically induced</subject><subject>Risk</subject><subject>Surgical Procedures, Operative</subject><subject>Treatment Outcome</subject><subject>Vitamin B Complex - administration & dosage</subject><issn>0003-3022</issn><issn>1528-1175</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFj1tLAzEQhYMotlb_ggTEx11z2Wx2fSvFGxR80eeaTSYlZTcpya5Yf70BK87LmWG-c5hB6IaSkpJW3hFaKg-pJLmYJJLxkhMpWWnUCZpTwZqCUilO0TwDvOCEsRm6SGmXRyl4c45mVNa1FLWYo4_lZ3BGeQ04WOzdGMOUcPhyBrANEe_V6MCPCU_eQNwG57d4ULu8SVPcQjzge7zEUXkTBvcNBuvgc0bf53aMTvWX6MyqPsHVURfo_fHhbfVcrF-fXlbLdbFnvB0LDcyyRivd6oZVlRBgoWs7qDSp29oyamQFWhutaUN5tthaycYq6AirasP4Al3_5u6nbgCz2Uc3qHjY_L2agdsjoJJWvc03a5f-uaYVohWU_wDcv2g6</recordid><startdate>20070801</startdate><enddate>20070801</enddate><creator>MYLES, Paul S</creator><creator>LESLIE, Kate</creator><creator>CHAN, Matthew T. 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Cell therapy and gene therapy</topic><topic>Anesthetics, Inhalation - administration & dosage</topic><topic>Anesthetics, Inhalation - adverse effects</topic><topic>Anesthetics, Inhalation - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Female</topic><topic>Folic Acid - administration & dosage</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Nitrogen - administration & dosage</topic><topic>Nitrous Oxide - adverse effects</topic><topic>Nitrous Oxide - therapeutic use</topic><topic>Odds Ratio</topic><topic>Oxygen - administration & dosage</topic><topic>Postoperative Complications - chemically induced</topic><topic>Postoperative Nausea and Vomiting - chemically induced</topic><topic>Risk</topic><topic>Surgical Procedures, Operative</topic><topic>Treatment Outcome</topic><topic>Vitamin B Complex - administration & dosage</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>MYLES, Paul S</creatorcontrib><creatorcontrib>LESLIE, Kate</creatorcontrib><creatorcontrib>CHAN, Matthew T. V</creatorcontrib><creatorcontrib>FORBES, Andrew</creatorcontrib><creatorcontrib>PAECH, Michael J</creatorcontrib><creatorcontrib>PEYTON, Philip</creatorcontrib><creatorcontrib>SILBERT, Brendan S</creatorcontrib><creatorcontrib>PASCOE, Elaine</creatorcontrib><creatorcontrib>ENIGMA Trial Group</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><jtitle>Anesthesiology (Philadelphia)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>MYLES, Paul S</au><au>LESLIE, Kate</au><au>CHAN, Matthew T. V</au><au>FORBES, Andrew</au><au>PAECH, Michael J</au><au>PEYTON, Philip</au><au>SILBERT, Brendan S</au><au>PASCOE, Elaine</au><aucorp>ENIGMA Trial Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Avoidance of nitrous oxide for patients undergoing major surgery : A randomized controlled trial</atitle><jtitle>Anesthesiology (Philadelphia)</jtitle><addtitle>Anesthesiology</addtitle><date>2007-08-01</date><risdate>2007</risdate><volume>107</volume><issue>2</issue><spage>221</spage><epage>231</epage><pages>221-231</pages><issn>0003-3022</issn><eissn>1528-1175</eissn><coden>ANESAV</coden><abstract>Nitrous oxide is widely used in anesthesia, often administered at an inspired concentration around 70%. Although nitrous oxide interferes with vitamin B12, folate metabolism, and deoxyribonucleic acid synthesis and prevents the use of high inspired oxygen concentrations, the consequences of these effects are unclear.
Patients having major surgery expected to last at least 2 h were randomly assigned to nitrous oxide-free (80% oxygen, 20% nitrogen) or nitrous oxide-based (70% N2O, 30% oxygen) anesthesia. Patients and observers were blind to group identity. The primary endpoint was duration of hospital stay. Secondary endpoints included duration of intensive care stay and postoperative complications; the latter included severe nausea and vomiting, and the following major complications: pneumonia, pneumothorax, pulmonary embolism, wound infection, myocardial infarction, venous thromboembolism, stroke, awareness, and death within 30 days of surgery.
Of 3,187 eligible patients, 2,050 consenting patients were recruited. Patients in the nitrous oxide-free group had significantly lower rates of major complications (odds ratio, 0.71; 95% confidence interval, 0.56-0.89; P = 0.003) and severe nausea and vomiting (odds ratio, 0.40; 95% confidence interval, 0.31-0.51; P < 0.001), but median duration of hospital stay did not differ substantially between groups (7.0 vs. 7.1 days; P = 0.06). Among patients admitted to the intensive care unit postoperatively, those in the nitrous oxide-free group were more likely to be discharged from the unit on any given day than those in the nitrous oxide group (hazard ratio, 1.35; 95% confidence interval, 1.05-1.73; P = 0.02).
Avoidance of nitrous oxide and the concomitant increase in inspired oxygen concentration decreases the incidence of complications after major surgery, but does not significantly affect the duration of hospital stay. The routine use of nitrous oxide in patients undergoing major surgery should be questioned.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott</pub><pmid>17667565</pmid><doi>10.1097/01.anes.0000270723.30772.da</doi><tpages>11</tpages></addata></record> |
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| ispartof | Anesthesiology (Philadelphia), 2007-08, Vol.107 (2), p.221-231 |
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| subjects | Adolescent Adult Anesthesia Anesthesia Recovery Period Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Anesthetics, Inhalation - administration & dosage Anesthetics, Inhalation - adverse effects Anesthetics, Inhalation - therapeutic use Biological and medical sciences Female Folic Acid - administration & dosage Humans Kaplan-Meier Estimate Length of Stay - statistics & numerical data Male Medical sciences Nitrogen - administration & dosage Nitrous Oxide - adverse effects Nitrous Oxide - therapeutic use Odds Ratio Oxygen - administration & dosage Postoperative Complications - chemically induced Postoperative Nausea and Vomiting - chemically induced Risk Surgical Procedures, Operative Treatment Outcome Vitamin B Complex - administration & dosage |
| title | Avoidance of nitrous oxide for patients undergoing major surgery : A randomized controlled trial |
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