The sevoflurane‐sparing effect of nitrous oxide: a clinical study

Jakobsson, Jan; Heidvall, M.; Davidson, S.

doi:10.1034/j.1399-6576.1999.430408.x

Cited by 44 publications

(20 citation statements)

References 6 publications

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“…2) at the same point (11 min) in our study, which used an older patient sample. In our study, the shorter times to eye opening and to extubation in the nitrous oxide group parallel the findings of Jakobsson et al 21 In that investigation, 42 patients underwent minor surgery during spontaneous ventilation via laryngeal mask breathing sevoflurane. 21 Time to removal of the laryngeal mask at the end of the procedure was 3.4 min shorter in the group that had received nitrous oxide.…”

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confidence: 91%

Nitrous Oxide Diffusion and the Second Gas Effect on Emergence from Anesthesia

et al. 2011

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Background: Rapid elimination of nitrous oxide from the lungs at the end of inhalational anesthesia dilutes alveolar oxygen, producing "diffusion hypoxia." A similar dilutional effect on accompanying volatile anesthetic agent has not been evaluated and may impact the speed of emergence. Methods: Twenty patients undergoing surgery were randomly assigned to receive an anesthetic maintenance gas mixture of sevoflurane adjusted to bispectral index, in airoxygen (control group) versus a 2:1 mixture of nitrous oxideoxygen (nitrous oxide group). After surgery, baseline arterial and tidal gas samples were taken. Patients were ventilated with oxygen, and arterial and tidal gas sampling was repeated at 2 and 5 min. Arterial sampling was repeated 30 min after surgery. Sevoflurane partial pressure was measured in blood by the double headspace equilibration technique and in tidal gas using a calibrated infrared gas analyzer. Time to eye opening and time extubation were recorded. The primary endpoint was the reduction in sevoflurane partial pressures in blood at 2 and 5 min. Results: Relative to baseline, arterial sevoflurane partial pressure was 39% higher at 5 min in the control group (P Ͻ 0.04) versus the nitrous oxide group. At 30 min the difference was not statistically significant. Time to eye opening (8.7 vs. 10.1 min) and time to extubation (11.0 vs.13.2 min) were shorter in the nitrous oxide group versus the control group (P Ͻ 0.04). Conclusions: Elimination of nitrous oxide at the end of anesthesia produces a clinically significant acceleration in the

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confidence: 91%

Nitrous Oxide Diffusion and the Second Gas Effect on Emergence from Anesthesia

et al. 2011

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“…In the present study, the MAC values sevoflurane-sparing effect by N2O than previously reported [9], the result is more applicable clinically.…”

Section: Resultssupporting

confidence: 62%

“…Group N: received nitrous oxide and oxygen with 0.5 inspired fraction of oxygen. A previous clinical study on the volatile anesthetic-sparing effect by N2O [9] showed that 66% N2O spared sevoflurane consumption by 60% during short ambulatory knee arthroscopy, which is greater than result of our study, likely due to fentanyl administration (2 g/kg) during anesthetic induction in the previous study. The sevoflurane-sparing effect by N2O…”

Section: Resultscontrasting

confidence: 58%

“…First method involves the difference in weight of the vaporizer before and after anesthesia divided by the density of inhalation anesthetic [9,12]. This method cannot serially measure the consumptions during anesthesia induction, maintenance, and emergence because of one time measurement after the end of anesthesia.…”

Section: Resultsmentioning

confidence: 99%

“…Jakobsson et al [9] reported that 66% N2O caused reduction in sevoflurane consumption by 60% and anesthetic cost by 41%.…”

Section: Introductionmentioning

confidence: 99%

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The economic evaluation of nitrous oxide in sevoflurane anesthesia

Kim

Choi

et al. 2017

Anesth Pain Med

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This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.Background: Nitrous oxide (N2O) is much cheaper than recently introduced volatile anesthetics such as sevoflurane and desflurane, and can reduce the consumption of these anesthetics. The use of N2O is under current debate. The purpose of this study was to evaluate economic effect of 50% N2O during sevoflurane anesthesia in Korea. Methods: Seventy patients were randomly allocated to Group A or Group N. Anesthesia induction was performed using propofol, rocuronium, and 3-5% of sevoflurane with air (Group A) or 50% N2O (Group N). Fresh gas flow (FGF) was 6 L/min during induction, and 3 L/min for maintenance. Mean arterial pressure (MAP), heart rate (HR), bispectral index (BIS), and minimum alveolar concentration (MAC) were recorded. The consumption of sevoflurane was measured at every 10 minutes for the first 1 hour. The economic effect was analyzed based on the payment criterion of Korean National Health Insurance Service. Results: MAP, HR, BIS, and MAC showed no differences between the two groups. The sevoflurane consumptions for the first 1 hour were 39.2 ± 6.3 ml in Group A and 29.2 ± 4.9 ml in Group N (P ＜ 0.01); and the N2O consumption was 93.7 ± 1.5 L in Group N. The total costs of inhaled anesthetics were 16,190 (14.8

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Role of Nitrous Oxide in Ambulatory Anaesthesia

Billingham

Smith

2014

Curr Anesthesiol Rep

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As the oldest anaesthetic still in routine use, the continued role of nitrous oxide is frequently questioned. There are a few well-defined situations in which nitrous oxide is contraindicated or undesirable; it is environmentally damaging and known to be toxic with prolonged exposure. However, evidence of serious harm is relatively lacking and mostly relates to prolonged and major surgery. In the ambulatory setting, the adverse effects of nitrous oxide are more limited and of minimal clinical relevance. Furthermore, there are numerous benefits which are not easily replicated by possible alternatives. Specifically, nitrous oxide improves the quality, speed and safety of induction of anaesthesia, enhances the quality of the maintenance phase, facilitates faster recovery and may reduce the occurrence of chronic postoperative pain, all with minimal adverse effects and while also reducing overall costs. Except in very specific circumstances, the minimal disadvantages and considerable benefits suggest that nitrous oxide still retains a valuable place in modern ambulatory anaesthesia.

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The sevoflurane‐sparing effect of nitrous oxide: a clinical study

Abstract: Nitrous oxide was found to be cost-effective for use during short ambulatory knee arthroscopy.

Cited by 44 publications

References 6 publications

Nitrous Oxide Diffusion and the Second Gas Effect on Emergence from Anesthesia

Nitrous Oxide Diffusion and the Second Gas Effect on Emergence from Anesthesia

The economic evaluation of nitrous oxide in sevoflurane anesthesia

Role of Nitrous Oxide in Ambulatory Anaesthesia

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