Avoidance of Nitrous Oxide for Patients Undergoing Major Surgery

Abstract

Avoidance of nitrous oxide and the concomitant increase in inspired oxygen concentration decreases the incidence of complications after major surgery, but does not significantly affect the duration of hospital stay. The routine use of nitrous oxide in patients undergoing major surgery should be questioned.

The WHO recommendation for 80% perioperative oxygen is poorly justified

“…These studies prompted many others. So far, there have been 6 published trials with 3265 patients reporting positive results with increased FiO2 [3,4,9,14,17,22]. On the other hand 7 trials including 2992 patients reported no benefit of 80% inspired oxygen (.…”

Review article: The anesthesiologist’s role in the prevention of surgical site infections

“…While not a primary end point of the ENIGMA study, the hyperoxia group did have a lower incidence of wound infections (adjusted OR 0.72; 95% CI 0.52 to 0.98; P = 0.036). 34 Conversely, Pryor et al 35 randomized 165 abdominal surgery patients to receive either 80% or 35% inspired oxygen over a similar time period. This study actually found that the rates of SSI were increased in the hyperoxia group (25.0% vs 11.3%; P = 0.03).…”

An overview of quality and safety in health care

“…23 Large randomized controlled trials (RCTs) that address simple but important questions in clinical practice, with substantive patient outcomes as endpoints, are the cornerstone of advancing effectiveness in anesthesia; a number of excellent examples have been published in recent years. [33][34][35][36] The establishment of formal networks, such as the Outcomes Research Consortium, 37 the Australian and New Zealand College of Anaesthetists (ANZCA) Trials Group, 38 and the Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group 39 has substantially facilitated the conduct of large high-quality RCTs to provide reliable and clinically relevant evidence to guide the management of patients undergoing surgery or requiring critical care.…”

“…23 Des études randomisées contrôlées (ERC) d'envergure qui traitent de questions simples mais importantes dans la pratique clinique, avec comme critères d'évaluation des devenirs significatifs pour les patients, sont la pierre angulaire pour faire avancer l'efficacité en anesthésie; plusieurs excellents exemples ont été publiés au cours des dernières années. [33][34][35][36] …”