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

Janiszewski, Debra; Galinkin, Jeffrey L.; Klock, P. Allan; Coalson, Dennis W.; Pardo, Helene; Zacny, James P.

doi:10.1213/00000539-199905000-00034

Cited by 16 publications

(7 citation statements)

References 24 publications

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“…141 Further understanding of the anesthetic and analgesic actions of nitrous oxide will help us to identify clinical situations where it has most benefit. As mentioned previously, its use in the very young 29 or in combination with a GABAergic anesthetic agent 26,33 for analgesia may be confounded, and therefore we may not realize its profound analgesic effects in these settings. However, nitrous oxide is used by many pediatric anesthesiologists for gaseous induction where its nonirritant quality and the second gas effect are unique attributes.…”

Section: Discussionmentioning

confidence: 99%

“…Some clinical evidence supports this view; in healthy volunteers inhaling subanesthetic concentrations of sevoflurane and nitrous oxide, the sevoflurane element decreases nitrous oxide's analgesic efficacy 33 (fig. 2).…”

Section: Is There Overlap Between Nitrous Oxide's Analgesic and Anestmentioning

confidence: 96%

“…؉ Significant increase from the 0% sevoflurane/30% nitrous oxide ratings. Reproduced from Janiszewski et al 33 ; used with permission. and halogenated volatile anesthetics; however, the addition of nitrous oxide in this context should not be as an analgesic but for the same indication as other anesthetic agents.…”

Section: Fig 2 Effects Of Sevoflurane and Nitrous Oxide On Ratings mentioning

confidence: 99%

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Biologic Effects of Nitrous Oxide

Weimann²,

2008

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Nitrous oxide is the longest serving member of the anesthesiologist's pharmacologic armamentarium but remains a source of controversy because of fears over its adverse effects. Recently, the Evaluation of Nitrous oxide In a Gas Mixture for Anaesthesia (ENIGMA) trial reported that nitrous oxide use increases postoperative complications; further preclinical reports have suggested that nitrous oxide may contribute to neurocognitive dysfunction in the young and elderly. Therefore, nitrous oxide's longevity in anesthetic practice is under threat. In this article, the authors discuss the evidence for the putative toxicity of nitrous oxide, from either patient or occupational exposure, within the context of the mechanism of nitrous oxide's action. Although it would seem prudent to avoid nitrous oxide in certain vulnerable populations, current evidence in support of a more widespread prescription from clinical practice is unconvincing.

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Section: Discussionmentioning

confidence: 99%

Section: Is There Overlap Between Nitrous Oxide's Analgesic and Anestmentioning

confidence: 96%

Section: Fig 2 Effects Of Sevoflurane and Nitrous Oxide On Ratings mentioning

confidence: 99%

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Biologic Effects of Nitrous Oxide

Weimann²,

2008

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“…Even after emerging from anesthesia, patients can exhibit cognitive impairment that lasts for hours (Larsen et al 2000). The cognitive abilities of elderly patients can be impaired for even longer periods after anesthesia was terminated (Chen et al 2001). Even subanesthetic doses of drugs like sevoflurane cause significant cognitive impairment (Galinkin et al 1997;Janiszewski et al 1999).…”

Section: Discussionmentioning

confidence: 99%

Caffeine accelerates recovery from general anesthesia via multiple pathways

Fong

Khokhar

Chowdhury

et al. 2017

Journal of Neurophysiology

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Various studies have explored different ways to speed emergence from anesthesia. Previously, we have shown that three drugs that elevate intracellular cAMP (forskolin, theophylline, and caffeine) accelerate emergence from anesthesia in rats. However, our earlier studies left two main questions unanswered. First, were cAMP-elevating drugs effective at all anesthetic concentrations? Second, given that caffeine was the most effective of the drugs tested, why was caffeine more effective than forskolin since both drugs elevate cAMP? In our current study, emergence time from anesthesia was measured in adult rats exposed to 3% isoflurane for 60 min. Caffeine dramatically accelerated emergence from anesthesia, even at the high level of anesthetic employed. Caffeine has multiple actions including blockade of adenosine receptors. We show that the selective A adenosine receptor antagonist preladenant or the intracellular cAMP ([cAMP])-elevating drug forskolin, accelerated recovery from anesthesia. When preladenant and forskolin were tested together, the effect on anesthesia recovery time was additive indicating that these drugs operate via different pathways. Furthermore, the combination of preladenant and forskolin was about as effective as caffeine suggesting that both A receptor blockade and [cAMP] elevation play a role in caffeine's ability to accelerate emergence from anesthesia. Because anesthesia in rodents is thought to be similar to that in humans, these results suggest that caffeine might allow for rapid and uniform emergence from general anesthesia in humans at all anesthetic concentrations and that both the elevation of [cAMP] and adenosine receptor blockade play a role in this response. Currently, there is no method to accelerate emergence from anesthesia. Patients "wake" when they clear the anesthetic from their systems. Previously, we have shown that caffeine can accelerate emergence from anesthesia. In this study, we show that caffeine is effective even at high levels of anesthetic. We also show that caffeine operates by both elevating intracellular cAMP levels and by blocking adenosine receptors. This complicated pharmacology makes caffeine especially effective in accelerating emergence from anesthesia.

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“…1 12-14 16 17 In contrast to our study, results from human laboratory tests have reported the absence of analgesic properties with inhalation anaesthetic agents. 18 However, these studies used a nociceptive pain stimulus completely different from labour pain, which is visceral in origin. In comparative studies, Entonox Ò has also been frequently used as a control to verify the inhalation agents' analgesic effects.…”

Section: Sevoflurane Entonox Sevofluranementioning

confidence: 99%