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Cited by 13Anesthesia and Sedative AgentsBiomedical and Chemical ResearchAnesthesia and Pain Management

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Nitrous oxide and perioperative outcomes

Ko, Hanjo, Kaye, Alan David, Urman, Richard D.·2014·Journal of Anesthesia
DOI 10.1007/s00540-013-1729-y
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Abstract

There is emerging evidence related to the effects of nitrous oxide on important perioperative patient outcomes. Proposed mechanisms include metabolic effects linked to elevated homocysteine levels and endothelial dysfunction, inhibition of deoxyribonucleic acid and protein formation, and depression of chemotactic migration by monocytes. Newer large studies point to possible risks associated with the use of nitrous oxide, although data are often equivocal and inconclusive. Cardiovascular outcomes such as stroke or myocardial infarction were shown to be unchanged in previous studies, but the more recent Evaluation of Nitrous Oxide in the Gas Mixture for Anesthesia I trial shows possible associations between nitrous oxide and increased cardiovascular and pulmonary complications. There are also possible effects on postoperative wound infections and neuropsychological function, although the multifactorial nature of these complications should be considered. Teratogenicity linked to nitrous oxide use has not been firmly established. The use of nitrous oxide for routine anesthetic care may be associated with significant costs if complications such as nausea, vomiting, and wound infections are taken into consideration. Overall, definitive data regarding the effect of nitrous oxide on major perioperative outcomes are lacking. There are ongoing prospective studies that may further elucidate its role. The use of nitrous oxide in daily practice should be individualized to each patient's medical conditions and risk factors.

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  • The reduced consumption of inhalational anesthetics when N2O is used does not result in net savings because expenses for N2O exceed the additional costs for inhalational anesthetics and intravenous analgesics.

    “Nevertheless, Baum et al. showed that expenses for the use of N2O—such as technical maintenance for the central gas piping system, antiemetic prophylaxis, and the inhalational anesthetic itself—exceed the additional costs for inhalational anesthetics and intravenous analgesics.60,64 Therefore, the reduced consumption of inhalational anesthetics does not result in net savings.”

    From A call for immediate climate action in anesthesiology: routine use of minimal or metabolic fresh gas flow reduces our ecological footprint (2023) · cites this paper as [60]

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References 95 · Cited by 13

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Metadata

Authors
Ko, H., Kaye, A. D., & Urman, R. D.
Affiliations
  • Brigham and Women's Hospital (US)
  • Louisiana State University (US)
Corresponding author
Urman, Richard D.
ORCID
Venue
Journal of Anesthesia
Publisher
Springer Science and Business Media LLC
Published
2013-10-27
Volume
28
Issue
3
Pages
420-428
ISSN
  • 0913-8668 (ISSN-L)
  • 1438-8359
DOI
10.1007/s00540-013-1729-y
OpenAlex
W2075211437
Cited by
13
References
95
Citations by year
2025: 1 · 2023: 1 · 2022: 2 · 2021: 1 · 2018: 2 · 2017: 2 · 2015: 4
FWCI
0.30
Type
journal article
Language
en
Open access
closed
Licence
www.springer.com/tdm (tdm)
Locations
  • Journal of Anesthesia (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
  • Health Sciences › Medicine › Physiology (medical) › Biomedical and Chemical Research
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Pain Management
Keywords
nitrous oxide, perioperative outcomes, homocysteine, endothelial dysfunction, cardiovascular complications, pulmonary complications, surgical site infection, neuropsychological performance, teratogenicity, anesthesia costs, monocyte chemotaxis, stroke, myocardial infarction
MeSH terms
Cardiovascular Diseases, Humans, Lung Diseases, Nausea, Nitrous Oxide, Postoperative Complications, Risk Factors, Surgical Wound Infection, Anesthetics, Inhalation, Analgesics, Non-Narcotic

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