The Effects of Subanesthetic Concentrations of Sevoflurane and Nitrous Oxide, Alone and in Combination, on Analgesia, Mood, and Psychomotor Performance in Healthy Volunteers

Dj, Janiszewski; Galinkin, Jeffrey L.; Pa, Klock; Coalson, Dennis W.; Pardo, Helene; Jp, Zacny

doi:10.1097/00000539-199905000-00034

Cited by 11 publications

(4 citation statements)

References 24 publications

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“…All previous studies of anaesthetic mixtures appear to have been at macro‐ or micro‐level. Third, in common with Janiszewski et al , they have demonstrated potentiation between the agents on some parameters (EEG burst suppression) while showing antagonism on others (isolectric EEG).…”

Section: The Possibility Of Infra‐additive Effects In Anaesthetic Commentioning

confidence: 53%

“…In humans at macro‐level, N 2 O has been reported to reduce ‐ not increase ‐ self‐reported feelings of sleepiness with low dose sevoflurane; while in turn sevoflurane antagonised the analgesic effects of N 2 O . Interestingly, Janiszewski et al found that the two agents were additive in their depressive effects on psychomotor performance, suggesting that agents can be differently additive, synergistic or infra‐additive on different macro‐endpoints.…”

Section: The Possibility Of Infra‐additive Effects In Anaesthetic Commentioning

confidence: 99%

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When anaesthetics collide: antagonism of one agent by another?

Pandit

2017

Anaesthesia

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Section: The Possibility Of Infra‐additive Effects In Anaesthetic Commentioning

confidence: 53%

Section: The Possibility Of Infra‐additive Effects In Anaesthetic Commentioning

confidence: 99%

When anaesthetics collide: antagonism of one agent by another?

Pandit

2017

Anaesthesia

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“…This was explained by the predominantly subcortical antinociceptive action of N 2 O combined with a weak depressant effect on cortical neurons. 13 Subanaesthetic concentrations of sevoflurane decrease the analgesic effect of N 2 O, 15 which is explained by the stimulation by supraspinal GABA A agonists, such as volatile anaesthetics 16 and benzodiazepines. 17 The interplay of mechanisms may explain the differences in the EEG effects that have been observed during different drug concentrations and combinations.…”

Section: Resultsmentioning

confidence: 99%

Entropy of the electroencephalogram as applied in the M-Entropy S/5™ Module (GE Healthcare) during increases in nitrous oxide and constant sevoflurane concentrations

Smith

Spijkerman

Becker

et al. 2010

Southern African Journal of Anaesthesia and Analgesia

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Background: It has been suggested that spectral entropy of the electroencephalogram as applied in the M-Entropy S/5 TM Module (GE Healthcare) does not detect the effects of nitrous oxide (N 2 O). The aim of this study was to investigate the effect on entropy by graded increases in N 2 O concentrations in the presence of a constant concentration of sevo urane, in the absence of surgical stimulation. Method: This single-blind, randomised study was conducted at an altitude of approximately 1 400 m. Patients received sevo urane 2% (1.7% at sea level) and N 2 O, at end-tidal concentrations of 0%, 10%, 20%, 30%, 40%, 50%, 60% or 70% (equivalent to 8.5%, 17%, 25.5%, 34%, 42.6%, 51.1% and 59.6% at sea level). Entropy was measured before, during and after N 2 O administration. The absolute changes and ratios o f entropy relative to the baseline were calculated. Between-and within-group comparisons were made using analysis of variance and covariance. Results: None of the entropy variables differed signi cantly within and between groups before and after N 2 O administration. Within-group analysis revealed that entropy during N 2 O administration was signi cantly lower than before or after N 2 O administration (P < 0.007). While a minor clinical but statistically signi cant linear relationship was observed between increasing N 2 O concentration and decreasing entropy from N 2 O 0% to 60%, a steeper and clinically important decrease (relative change > 20%) was noted at N 2 O > 60% (> 51% at sea level). Conclusions: The M-Entropy Module S/5TM responds to increasing concentrations of N 2 O in the presence of 2% (1.7% at sea level) sevo urane, in the absence of surgical stimulation. There is a linear relationship between increasing N 2 O concentrations and decreasing entropy with a steep and clinically important decrease at N 2 O > 60% (> 51% at sea level). The in uence of ambient pressure on the partial pressures, which determine the effects of anaesthetic agents, must be taken into account.

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“…The tests included visual scanning, auditory reaction time, eye-hand coordination, mental flexibility, sustained attention, speed of information processing and memory 12 13 14. …”

Section: Methodsmentioning

confidence: 99%

Psychomotor and cognitive effects of 15-minute inhalation of methoxyflurane in healthy volunteers: implication for post-colonoscopy care

et al. 2016

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Background and study aims: Colonoscopy with portal inhaled methoxyflurane (Penthrox) is highly feasible with low sedation risk and allows earlier discharge. It is unclear if subjects can return to highly skilled psychomotor skill task shortly after Penthrox assisted colonoscopy. We evaluated the psychomotor and cognitive effects of 15-minute inhalation of Penthrox in adults. Patients and methods: Sixty healthy volunteers (18 to 80 years) were studied on 2 occasions with either Penthrox or placebo in a randomized, double-blind fashion. On each occasion, the subject’s psychomotor function was examined before, immediately, 30, 60, 120, 180 and 240 min after a 15-minute inhalation of studied drug, using validated psychomotor tests (Digit Symbol Substitution Test (DSST), auditory reaction time (ART), eye-hand coordination (EHC) test, trail making test (TMT) and logical reasoning test (LRT). Results: Compared to placebo, a 15-minute Penthrox inhalation led to an immediate but small impairment of DSST (P < 0.001), ART (P < 0.001), EHC (P < 0.01), TMT (P = 0.02) and LRT (P = 0.04). In all subjects, the performance of all 5 tests normalized by 30 minutes after inhalation, and was comparable to that with placebo. Although increasing age was associated with a small deterioration in psychomotor testing performance, the magnitude of Penthrox effects remained comparable among all age groups. Conclusions: In all age groups, a 15-minute Penthrox inhalation induces acute but short-lasting impairment of psychomotor and cognitive performance, which returns to normal within 30 minutes , indicating that subjects who have colonoscopy with Penthrox can return to highly skilled psychomotor skills tasks such as driving and daily work the same day.

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The Effects of Subanesthetic Concentrations of Sevoflurane and Nitrous Oxide, Alone and in Combination, on Analgesia, Mood, and Psychomotor Performance in Healthy Volunteers

Cited by 11 publications

References 24 publications

When anaesthetics collide: antagonism of one agent by another?

When anaesthetics collide: antagonism of one agent by another?

Entropy of the electroencephalogram as applied in the M-Entropy S/5™ Module (GE Healthcare) during increases in nitrous oxide and constant sevoflurane concentrations

Psychomotor and cognitive effects of 15-minute inhalation of methoxyflurane in healthy volunteers: implication for post-colonoscopy care

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