Nitrous Oxide Does Not Induce Myocardial Ischemia in Patients with Ischemic Heart Disease and Poor Ventricular Function

Influence of Nitrous Oxide Anesthesia, B-Vitamins, andMTHFRGene Polymorphisms on Perioperative Cardiac Events

“…Several smaller studies in high-risk patients observed no effect of nitrous oxide on myocardial ischemia, 4–6 whereas a recent study showed an increased risk for ischemic electrocardiogram changes; 1 however, in this latter study no cardiac biomarkers or clinical outcomes were reported. The only large clinical trial investigating nitrous oxide and cardiovascular outcomes, the ENIGMA trial, reported an inconclusive, statistically non-significant increase in the incidence of myocardial infarction from 0.7% (n=7/997) to 1.3% (n=13/1015, OR 0.54, 95% CI 0.22 – 1.37, p= 0.2) in patients receiving nitrous oxide.…”

Anesthesia for cesarean section in a patient with placenta previa and methylenetetrahydrofolate reductase deficiency

“…Badner et al [15] have shown that N 2 Oinduced homocysteine increases are associated with increased postoperative myocardial ischemia, with a peak incidence of postoperative myocardial infarctions on the first postoperative night [29], which would temporally coincide with sequelae of N 2 O-induced homocysteine increases. In their study, Badner et al found that the use of N 2 O was a significant predictor of postoperative ischemia in contrast to previous work, in which N 2 O was not shown to produce an increase in myocardial ischemia [30][31][32]. They related this finding to the fact that they looked for ischemia in the postoperative period by continuous monitoring, in contrast with other studies [15].…”

Factors to Weigh in While Administering Nitrous Oxide Anesthesia [Response to Letter]

“…Mitchell et al reported that N 2 O did not induce myocardial ischemia in patients with ischemic heart disease and poor ventricular function. 1 The ENIGMA-II trial, a randomised, single-blind trial, showed no evidence that N 2 O increases the risk of cardiovascular complications after major non-cardiac surgery. 2 We believe that 30% low-concentration N 2 O anesthesia can be safely used in patients with heart failure.…”