Effect of Nitrous Oxide Anesthesia on Plasma Homocysteine and Endothelial Function

Myles, Paul S.; Chan, Matthew T. V.; Kaye, David M.; McIlroy, David R.; Lau, Chung Wai; Symons, Joel Ari; Chen, Shaohui

doi:10.1097/aln.0b013e31818629db

Cited by 87 publications

(57 citation statements)

References 35 publications

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“…Desflurane appears to exert worse pulmonary vascular effects than isoflurane, probably through sympathetic activation [42,43]. Some studies suggest that nitrous oxide as a supplemental anaesthetic agent may increase PVR, especially in those with pre-existing elevated PVR [44], and it may also adversely influence endothelial function [45]. An increase in adverse cardiovascular events following its use in major surgery has been observed [46], possibly also through adverse pulmonary vascular effects of increased sympathomimetic stimulation [47,48] or hypoxia [49], and a study addressing these questions is ongoing [50].…”

Section: Discussionmentioning

confidence: 99%

Noncardiothoracic nonobstetric surgery in mild-to-moderate pulmonary hypertension

Price¹,

Montani²,

Jaïs³

et al. 2009

Eur Respir J

121

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The anaesthetic management and follow-up of well-characterised patients with pulmonary arterial hypertension presenting for noncardiothoracic nonobstetric surgery has rarely been described.The details of consecutive patients and perioperative complications during the period January 2000 to December 2007 were reviewed. Repeat procedures in duplicate patients were excluded. Longer term outcomes included New York Heart Association (NYHA) functional class, 6-min walking distance and invasive haemodynamics.A total of 28 patients were identified as having undergone major (57%) or minor surgery under general (50%) and regional anaesthesia. At the time of surgery, 75% of patients were in NYHA functional class I-II. Perioperative deaths occurred in 7%. Perioperative complications, all related to pulmonary hypertension, occurred in 29% of all patients and in 17% of those with no deaths during scheduled procedures. Most (n511, 92%) of the complications occurred in the first 48 h following surgery. In emergencies (n54), perioperative complication and death rates were higher (100 and 50%, respectively; p,0.005). Risk factors for complications were greater for emergency surgery (p,0.001), major surgery (p50.008) and a long operative time (193 versus 112 min; p50.003). No significant clinical or haemodynamic deterioration was seen in survivors at 3-6 or 12 months of post-operative follow-up.Despite optimal management in this mostly nonsevere pulmonary hypertension population, perioperative complications were common, although survivors remained stable. Emergency procedures, major surgery and long operations were associated with increased risk.

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Section: Discussionmentioning

confidence: 99%

Noncardiothoracic nonobstetric surgery in mild-to-moderate pulmonary hypertension

Price¹,

Montani²,

Jaïs³

et al. 2009

Eur Respir J

121

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“…Whether this acute effect translates into clinical outcomes of relevance has been the research objective of two recent prospective randomized control trials in adults (4,6). In these trials, nitrous oxide-induced acute hyperhomocysteinemia (>13.4 µmol/L) was associated with increased risk of myocardial ischemia (6), and other major post-surgical complications (4).…”

Section: Introductionmentioning

confidence: 99%

“…A growing body of evidence indicates that homocysteine acutely rises as a side effect of exposure to nitrous oxide during surgery in adults (1)(2)(3)(4)(5)(6)(7)(8)(9). Homocysteine is an intermediary metabolite in metabolism of the sulfurcontaining amino acids.…”

Section: Introductionmentioning

confidence: 99%

Effect of Nitrous Oxide Exposure During Surgery on the Homocysteine Concentrations of Children

Pichardo¹,

Luginbuehl²,

Shakur³

et al. 2013

Survey of Anesthesiology

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In this study we determined the effect of nitrous oxide (N 2 O) on homocysteine concentrations in children and whether blood levels of folate, vitamin B12, B6, methylmalonic acid (MMA) and methylenetetrahydrofolate reductase C6777T genotype affected this relationship. Homocysteine was measured before and after N 2 O. Vitamin levels, MMA and genotype were determined preoperatively. Median age of the 32 participants was 11 months (3-126 months). All children had folate and B6 levels above deficiency values (7.4, 20nmol/L respectively). Five children had MMA levels indicating deficiency (≥0.21µmol/L). Postexposure homocysteine concentrations increased by 25% (P= <0.001). Duration of exposure and initial homocysteine concentrations were predictors of the increase (r 2 = 0.821, P= <0.001).Vitamin B12 and initial homocysteine concentrations were inversely associated (r 2 = 0.277, P= 0.004). Folate, vitamin B6 and genotype showed no effect. In conclusion, N 2 O exposure leads to increased homocysteine in children. Studies investigating benefit of pre-surgical vitamin B12 supplementation may prove worthwhile.iii ACKNOWLEDGMENTS

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“…In 2017 was an extensive study published which clearly demonstrated that postoperative adverse effects such as postoperative fever, wound infection, pneumonia, pulmonary atelectasis, and severe nausea or vomiting decreased when nitrous oxide was avoided [35]. Endothelial function was impaired after surgery in patients with cardiovascular disease, but seemingly only in those exposed to nitrous oxide [36]. The duration of nitrous oxide exposure strongly correlated with the extent of endothelial dysfunction.…”

Section: The Adverse Effects Of Nitrous Oxidementioning

confidence: 99%

Nitrous oxide. Should it still be used in pediatric medicine ? (Part 1)

Booij¹

2017

Medical news of the North Caucasus

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Effect of Nitrous Oxide Anesthesia on Plasma Homocysteine and Endothelial Function

Abstract: Nitrous oxide-based anesthesia increased plasma homocysteine and significantly impaired endothelial function in patients undergoing noncardiac surgery. Nitrous oxide-based anesthesia could be a risk factor for postoperative cardiovascular morbidity.

Cited by 87 publications

References 35 publications

Noncardiothoracic nonobstetric surgery in mild-to-moderate pulmonary hypertension

Noncardiothoracic nonobstetric surgery in mild-to-moderate pulmonary hypertension

Effect of Nitrous Oxide Exposure During Surgery on the Homocysteine Concentrations of Children

Nitrous oxide. Should it still be used in pediatric medicine ? (Part 1)

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