The effect of adding nitrous oxide on MAC of sevoflurane combined with two target-controlled concentrations of remifentanil in women

Albertin, A.; Casati, Andrea; Bergonzi, P. C.; Moizo, Elena; Lombardo, Francesca; Torri, G.

doi:10.1017/s0265021505000736

Cited by 10 publications

(13 citation statements)

References 19 publications

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“…Our scheme can achieve those targets earlier at much lower FGF compared with the aforementioned schemes. We included N 2 O in our scheme because of its second gas effect [10] and additive effect on decreasing MAC of inhalation anesthetics [11]. Our scheme is practicable and yields a rapid wash-in and a prediction for achieving each F A D from 1 to 6%, which is 2-MAC equivalent with 50% N 2 O, at 0.6, 1, 1.5, 2, 3, and 4 min.…”

Section: Discussionmentioning

confidence: 99%

1-1-12 One-Step Wash-In Scheme for Desflurane-Nitrous Oxide Low-Flow Anesthesia: Rapid and Predictable Induction

Sathitkarnmanee

Tribuddharat

Suttinarakorn

et al. 2014

BioMed Research International

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Background. We propose a 1-1-12 wash-in scheme for desflurane-nitrous oxide (N2O) low-flow anesthesia. The objective of our study was to determine the time to achieve alveolar concentration of desflurane (FAD) at 1, 2, 3, 4, 5, and 6%. Methods. We enrolled 106 patients scheduled for elective surgery under general anesthesia. After induction and intubation, wash-in was started with a fresh gas flow (FGF) of N2O : O2 1 : 1 L min−1 and vaporizer concentration of desflurane (FD) of 12%. Ventilation was controlled to maintain PACO2 at 30–35 mmHg. Results. The FAD rose rapidly from 0 to 4% in 2 min in a linear manner in 0.5 min increments. An FAD of 6% was achieved in 4 min in a linear fashion from FAD of 4% but in 1 min increments. An FAD of 1 to 6% occurred at 0.6, 1, 1.5, 2, 3, and 4 min. Heart rate during wash-in showed a statistically, albeit not clinically, significant pattern of increase. By contrast, blood pressure slightly decreased during this period. Conclusions. We developed a 1-1-12 wash-in scheme using a FGF of N2O : O2 1 : 1 L min−1 and FD of 12% for desflurane-nitrous oxide low-flow anesthesia. A respective FAD of 1, 2, 3, 4, 5, and 6% can be expected at 0.6, 1, 1.5, 2, 3, and 4 min.

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Section: Discussionmentioning

confidence: 99%

1-1-12 One-Step Wash-In Scheme for Desflurane-Nitrous Oxide Low-Flow Anesthesia: Rapid and Predictable Induction

Sathitkarnmanee

Tribuddharat

Suttinarakorn

et al. 2014

BioMed Research International

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“…Of these 12 studies, six did not include an intervention or comparator relevant to this review , in five studies the depth of anaesthesia differed between study arms [ and two papers reported on the ENIGMA‐2 study , which did not measure AAGA. Through this process we identified 22 publications covering 15 RCTs for inclusion in the review .…”

Section: Resultsmentioning

confidence: 99%

“…One study , although included in the qualitative synthesis of this review, could not be included in the primary analysis as the number of participants in each group was not reported. Eleven studies included a single comparison of a study group with nitrous oxide and a group without nitrous oxide , whereas four studies included more than one comparison . These ‘multi‐arm’ studies, included four or three comparison groups.…”

Section: Resultsmentioning

confidence: 99%

“…Eleven studies included a single comparison of a study group with nitrous oxide and a group without nitrous oxide , whereas four studies included more than one comparison . These ‘multi‐arm’ studies, included four or three comparison groups. The anaesthetic agents used in the studies varied, with seven using propofol , three using sevoflurane , three using isoflurane and two using desflurane .…”

Section: Resultsmentioning

confidence: 99%

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Nitrous oxide‐based vs. nitrous oxide‐free general anaesthesia and accidental awareness in surgical patients: an abridged Cochrane systematic review

et al. 2017

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Summary Accidental awareness during general anaesthesia can arise from a failure to deliver sufficient anaesthetic agent, or from a patient's resistance to an expected sufficient dose of such an agent. Awareness is ‘explicit’ if the patient is subsequently able to recall the event. We conducted a systematic review into the effect of nitrous oxide used as part of a general anaesthetic on the risk of accidental awareness in people over the age of five years undergoing general anaesthesia for surgery. We included 15 randomised controlled trials, 14 of which, representing a total of 3439 participants, were included in our primary analysis of the frequency of accidental awareness events. The awareness incidence rate was rare within these studies, and all were considered underpowered with respect to this outcome. The risk of bias across all studies was judged to be high, and 76% of studies failed adequately to conceal participant allocation. We considered the available evidence to be of very poor quality. There were a total of three accidental awareness events reported in two studies, one of which reported that the awareness was the result of a kink in a propofol intravenous line. There were insufficient data to conduct a meta‐ or sub‐group analysis and there was insufficient evidence to draw outcome‐related conclusions. We can, however, recommend that future studies focus on potentially high‐risk groups such as obstetric or cardiac surgery patients, or those receiving neuromuscular blocking drugs or total intravenous anaesthesia.

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“…9 However, adding nitrous oxide reduces the MAC of sevoflurane especially when using a remifentanil infusion. 13 Limitations for BIS monitoring exist. High electromyographic activity and electric device interference could create subtle artifact signal pollution without necessarily being displayed as artifacts.…”

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confidence: 99%

Bispectral Index-Monitored Anesthesia Technique for Transsternal Thymectomy

Maddali

Matreja

Zachariah

2009

Asian Cardiovasc Thorac Ann

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To evaluate the role of bispectral index monitoring as an adjunct to balanced anesthesia in patients with myasthenia gravis undergoing transsternal thymectomy without the use of neuromuscular blocking agents, 10 patients were enrolled into this prospective observational study. After oral midazolam premedication, general anesthesia was induced with fentanyl, propofol, and sevoflurane. Tracheal intubation was performed without neuromuscular blocking agents. During maintenance, continuous monitoring of physiological and bispectral index parameters was used to titrate the doses of remifentanil, propofol, and sevoflurane. Sevoflurane concentration and propofol doses were adjusted to achieve bispectral index values in the high 30s to low 40s. Propofol was discontinued when the sternum was approximated. Remifentanil infusion was stopped on subcutaneous tissue closure, and sevoflurane was switched off when nearing completion of skin closure. Tracheal extubation was performed when extubation criteria were met. On extubation, bispectral index levels were above 90. The median time from extubation to discontinuation of propofol was 28 +/- 4 min, that of remifentanil was 21 +/- 4 min, and it was 9 +/- 5 min for sevoflurane. Bispectral index monitoring provided excellent hemodynamic control during surgery, and allowed early problem-free tracheal extubation.

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The effect of adding nitrous oxide on MAC of sevoflurane combined with two target-controlled concentrations of remifentanil in women

Abstract: Adding 60% nitrous oxide reduces the MAC of sevoflurane by 70% when using a remifentanil concentration of 1 ng mL(-1) and 50% when using a remifentanil concentration of 3 ng mL(-1).

Cited by 10 publications

References 19 publications

1-1-12 One-Step Wash-In Scheme for Desflurane-Nitrous Oxide Low-Flow Anesthesia: Rapid and Predictable Induction

1-1-12 One-Step Wash-In Scheme for Desflurane-Nitrous Oxide Low-Flow Anesthesia: Rapid and Predictable Induction

Nitrous oxide‐based vs. nitrous oxide‐free general anaesthesia and accidental awareness in surgical patients: an abridged Cochrane systematic review

Bispectral Index-Monitored Anesthesia Technique for Transsternal Thymectomy

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