Adverse effects may occur when patients with air in the pleural space or in the cerebral ventricles breathe nitrous oxide. We developed an animal model to learn whether similar adverse effects are associated with the inhalation of nitrous oxide when air is present in the subcutaneous space. We induced extensive subcutaneous emphysema in swine and measured oxygen and carbon dioxide tensions in systemic arterial and mixed venous blood; cardiac output; intravaseular, airway, and pre-sternal subcutaneous pressures; total pulmonary-thoracic static compliance; and thoracic girth before and after a 45 minute period of breathing 75 per cent nitrous oxide in oxygen. Cardiac output decreased from 3.13 ---0.51 I/min to 2.40 -+ 0.62 l/rain (p < 0.05); no other values changed significantly. No significant adverse cardiorespiratory effects resulted from the transfer of inhaled nitrous oxide to the subcutaneous space in this animal model. KEY WORDS: ANAESTHETICS, GASES, nitrous oxide; COMPLICATIONS, subcutaneous emphysema.ALTHOUGH air-filled cavities in the body tend to decrease in size and to disappear spontaneously, during the inhalation of nitrous oxide the spaces increase in size until an equilibrium occurs. induced by nitrous oxide in swine with subcutaneous emphysema.
METHODSTen young swine weighing 20-25 kg were anaesthetized with intramuscular ketamine hydrochloride 20 mg-kg -I. A catheter for the administration of fluids and drugs was inserted into a vein of the ear, the trachea was intubated and anaesthesia and immobilization were maintained with intravenous thiamylal and pancuronium bromide. The lungs were ventilated with air from a time-cycled volume ventilator, maintaining Pact2 between 4.9 and 5.7 kPa (37 and 43 ton). Body temperature was monitored by a pulmonary artery thermistor and was maintained at 37.0 ---I~ by external infrared heating. A Swan-Ganz | thermodilution catheter was placed into the pulmonary artery through a high cervical jugular venous cutdown. Each animal received lactated Ringer's solution, 2-3 ml.kg-I/hour to maintain hydration.An 18-gauge Teflon | catheter was placed surgically into the carotid artery and a 12-gauge plastic catheter was placed into the subcutaneous tissue anterior to the sternum. Pressures from the arterial and central venous catheters, from the subcutaneous space and from the airway were transduced with a high fidelity pressure measurement