The association of nitrous oxide on length of stay in the postanesthesia care unit: a retrospective observational study

Abstract

Purpose To assess whether intraoperative use of nitrous oxide (N 2 O) as an adjunct to general anesthesia is associated with a shorter length of stay in the postanesthesia care unit (PACU).Methods We analyzed data from adult patients who underwent non-cardiothoracic surgery under general anesthesia between May 2008 and December 2018. We assessed the association between intraoperative low-and high-dose N 2 O and PACU length of stay. Results A total of 148,284 patients were included in the primary analysis. After adjusting for a priori defined confounders, a high dose of N 2 O significantly decreased PACU length of stay, with a calculated difference of -9.1 min (95% confidence interval [CI], -10.5 to -7.7; P \ 0.001). Patients who received high-dose N 2 O had a lower incidence of both short-and prolonged-duration of intraoperative hypotension (adjusted odds ratio [aOR], 0.85; 95% CI, 0.83 to 0.88; P\0.001 and aOR, 0.76; 95% CI, 0.73 to 0.80; P \ 0.001, respectively) and received a This article is accompanied by an editorial. Please see Can J Anesth 2021; this issue.

Use of nitrous oxide in contemporary anesthesia—an ongoing tug of war

“…rapportent l'analyse re ´trospective d'une base de donne ´es de 148 284 patients ayant be ´ne ´ficie ´d'une chirurgie non cardiaque, non thoracique, entre 2008 et 2018 (c'est-a `dire apre `s la publication des e ´tudes ENIGMA). 15 Un total de 54,5 % des patients avait rec ¸u du protoxyde d'azote au cours de l'intervention chirurgicale. Ayant recours a `une analyse ajuste ´e par un score de propension, les auteurs ont de ´crit une plus petite dure ´e de se ´jour d'environ neuf minutes dans la salle de re ´veil parmi les patients ayant rec ¸u une forte concentration de protoxyde d'azote comparativement aux patients n'en ayant pas rec ¸u.…”

“…In the current edition of the Journal, Obeidat et al report a retrospective database analysis of 148,284 patients receiving noncardiac, non-thoracic surgery performed between 2008 and 2018 (i.e., after the publication of the ENIGMA trials). 15 A total of 54.5% of patients received nitrous oxide during surgery. Using a propensity scoreadjusted analysis, the authors reported a shorter stay, by about nine minutes, in the postanesthesia care unit among patients having high-dose nitrous oxide compared with those who did not have nitrous oxide.…”

Please stop using nitrous oxide in routine clinical practice (comment on: Use of nitrous oxide in contemporary anesthesia—an ongoing tug of war)

“…We would like to comment on the recent editorial by Chan et al . 1 and their remarks on the study by Obeidat et al ., 2 stressing the role of nitrous oxide (N 2 O) in general anesthesia.…”