Visual Loss after Use of Nitrous Oxide Gas with General Anesthetic in Patients with Intraocular Gas Still Persistent Up to 30 days after Vitrectomy

Warning wristbands for patients with intra-ocular gas

“…Our proposal is also cost-effective as the wristbands are already freely available from the pharmaceutical company which supplies our intravitreal gas canisters. The use of wristbands to warn of the contraindication of nitrous oxide has previously been championed by Vote et al [ 4 ] and the use of such wristbands is already common practice in other units worldwide. We were delighted to present our use of wristbands at the Royal College Congress in May earlier this year [ 5 ].…”

The effect of nitrous oxide on intra‐ocular pressure

“…I would like to raise some of the potential issues surrounding the use of N 2 O in patients with a recent history of ophthalmic surgery. There have been several case reports regarding complications as a result of the use of N 2 O in patients who have undergone vitreoretinal procedures [2, 3]. In these patients, surgery may involve the deposition of a gas bubble into the eye to help maintain retinal attachment during healing.…”

“…In these patients, surgery may involve the deposition of a gas bubble into the eye to help maintain retinal attachment during healing. Gases commonly used by ophthalmic surgeons include sulphurhexafluoride and perfluoropropane [3]. These gases have been described as persisting for approximately 6 weeks following surgery [3, 4].…”

“…Gases commonly used by ophthalmic surgeons include sulphurhexafluoride and perfluoropropane [3]. These gases have been described as persisting for approximately 6 weeks following surgery [3, 4]. If N 2 O is then administered as part of a general anaesthetic, N 2 O will diffuse into any persisting gas bubble and cause it to expand, and IOP pressure may increase sufficiently to cause retinal or optic nerve ischaemia [3].…”

“…These gases have been described as persisting for approximately 6 weeks following surgery [3, 4]. If N 2 O is then administered as part of a general anaesthetic, N 2 O will diffuse into any persisting gas bubble and cause it to expand, and IOP pressure may increase sufficiently to cause retinal or optic nerve ischaemia [3]. Permanent visual loss may result, representing a disastrous and wholly avoidable complication.…”