The influence of nitrous oxide on recovery of bowel function after abdominal hysterectomy

Abstract

The influence of nitrous oxide on the recovery of bowel function was studied in 36 patients anaesthetised for elective abdominal hysterectomy with or without salpingo-oophorectomy. Patients were randomly assigned to receive either isoflurane in nitrous oxide and 30% oxygen (N2O group) or isoflurane in air and 30% oxygen (Air group). Anaesthetic management included thiopentone, fentanyl, suxamethonium and atracurium. The lungs were not ventilated prior to intubation. Before closing the abdomen, the surgeon assessed the degree of distension of the intestines and the closing conditions. Postoperative nausea and vomiting was assessed 2, 6, 12 and 24 h after recovery from anaesthesia. The lapse of time before mobilisation and passing of flatus and faeces was recorded. The patients in the Air group were significantly older than the patients in the N2O group (48.9 years versus 44.0 years, P = 0.04); otherwise, there were no differences in the demographic data of the patients. We found no significant differences between the groups with respect to nausea and vomiting, distension of the intestines before closure of the abdomen, closing conditions, time elapsing before mobilisation, constipation before recovery of bowel function or time elapsing before passing of flatus. We found a statistically significant delay of 10.3 h in time elapsing before passing of faeces in the N2O group compared to the Air group (P = 0.04), suggesting a potentially adverse effect of nitrous oxide.(ABSTRACT TRUNCATED AT 250 WORDS)

Association between nitrous oxide and the incidence of postoperative nausea and vomiting in adults: a systematic review and meta‐analysis

“…This left 30 reports including 4598 patients (2297 in the N 2 O group and 2301 in the non‐N 2 O group) [39, 41–63]. The characteristics of each group, when pooled, are shown in Table 1.…”

Effects of nitrous oxide on intraoperative bowel distension

“…This is one of the longest periods of nitrous oxide exposure among the trials we evaluated. Some of the negative results were observed in shorter procedures [16,21] and it remains likely that nitrous oxide does not produce clinically important bowel distension in operations of short duration. As a methodological issue, other than Lewis [7] and Boulanger and Hardy [13], none of the investigators quantified bowel distension by measuring girth or intestinal circumference; instead, the surgeons blinded to the study protocol, usually rated it in terms of the clinically relevant parameter (i.e.…”

Nitrous oxide: laparoscopic surgery, bowel function, and PONV

“…O n the other hand, there are studies where no such effects were observed caused by nitrous oxide, for instance when propofol anaesthesia was combined with N20 (8)(9). In women undergoing hysterectomy with isoflurane anaesthesia, nitrous oxide caused no other adverse effects than a clinically insignificant delayed passing of faeces (10). However, when elderly patients are scheduled for a long-lasting laparotomy because of bowel obstruction with distension, it may be wise to avoid the administration of nitrous oxide.…”