Effect of nitrous oxide on middle ear pressure: a comparison between inhalational anaesthesia with nitrous oxide and TIVA

Karabiyik, Lale; Bozkırlı, Füsun; Çelebi, Hülya; Göksu, Nebil

doi:10.1097/00003643-199601000-00006

Cited by 28 publications

(28 citation statements)

References 11 publications

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“…Control of nausea and vomiting during dental sedation is a specific challenge. Nitrous oxide may cause emesis by stimulation of the sympathetic system through catecholamine release [20], pressurevolume changes in the middle ear [21,22], and alteration of gastric myoelectrical activity [23]. A previous prospective survey which analysed the factors affecting tolerance of the 50% N 2 O/O 2 premix in a wide range of clinical situations reported that the main factors associated with adverse events were age, concomitant drug administration, and longer duration of inhalation [24].…”

Section: Discussionmentioning

confidence: 99%

A clinical trial of efficacy and safety of inhalation sedation with a 50% nitrous oxide/oxygen premix (Kalinox™) in general practice

et al. 2011

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The current study aimed to verify if the safety and effectiveness of inhalation sedation with 50% nitrous oxide in oxygen (N(2)O/O(2)) is maintained when the premix is administrated by trained general practitioners in their dental surgeries compared to its use in the hospital. Success (completion of planned treatment), cooperation (modified Venham scale), and adverse events were recorded. The acceptability of the technique to the patients, the level of patient cooperation, the ease of use, and the satisfaction of the dentist were also evaluated. Thirty-three general practitioners included 549 patients and recorded 638 sessions of N(2)O/O(2) sedation for dental treatment. Of the sessions, 93.7% were successful in terms of both sedation and treatment. Patient cooperation was seen to improve under N(2)O/O(2) sedation, and for 91% of the sessions, the patients declared that they would like future treatment to be undertaken in the same way. No serious adverse events were recorded. Minor adverse events were noted for 10% of the sessions (behavioural, vagal, and digestive disorders). These results were similar to those found for sessions undertaken in hospital practice. The main difference was in the type of patient treated-more patients received N(2)O/O(2) sedation in general practice for a one-off indication or for dental phobia, and more patients with intellectual disability and more pre-cooperative children were treated in hospital practice. This study gives strong supporting evidence for the safety and effectiveness of inhalation sedation using 50% N(2)O/O(2) in general dental practice for healthy patients.

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Section: Discussionmentioning

confidence: 99%

A clinical trial of efficacy and safety of inhalation sedation with a 50% nitrous oxide/oxygen premix (Kalinox™) in general practice

et al. 2011

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“…Middle ear pressure (MEP) variation due to inhalant anesthesia has been reported by several authors [1][2][3][4][5]. In these studies halothane and nitrous oxide were used mostly as inhalant anesthetics.…”

Section: Introductionmentioning

confidence: 99%

Effects of sevoflurane and TIVA with propofol on middle ear pressure

Öztürk

Demiraran

İlçe

et al. 2006

International Journal of Pediatric Otorhinolaryngology

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“…Active and passive exchange of middle ear gases occurs constantly within the middle ear [20]. Poe, et al [21] reported that normal ETs had four consistent sequential movements: [1] palatal elevation causing passive, then active, rotation of the medial cartilaginous lamina; [2] lateral excursion of the lateral pharyngeal wall; [3] dilation of the lumen, caused primarily by tensor veli palatini muscle movement beginning distally and inferiorly, then opening proximally and superiorly; and [4] opening of the tubal valve at the isthmus caused by dilator tubae muscle contraction [21]. In the present study, sevoflurane is eliminated quickly, and CO 2 diffused into the middle ear cavity is removed quickly due to the function of the ET and also increased microcirculation.…”

Section: Discussionmentioning

confidence: 99%

“…Nitrous oxide has been demonstrated to cause a time-related increase in the pressure with accumulation in a closed environment, and this effect is also valid for the middle ear [1,2].…”

mentioning

confidence: 87%

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Sevoflurane vs. TIVA in Terms of Middle Ear Pressure During Laparoscopic Surgery

Güler¹,

Apan²,

Muluk³

et al. 2014

Adv Clin Exp Med

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Objectives. The aim of this study was to investigate the effects of CO 2 insufflation on the pressure of the middle ear cavity (PMEC) during laparoscopic surgery under total intravenous anesthesia (TIVA) with propofol or sevoflurane as an inhalational anesthetic maintenance. Material and Methods. Sixty patients who underwent laparoscopic/or non-laparoscopic surgery under general anesthesia were included in the study. For anesthetic maintenance with inhalation agents, 20 non-laparoscopic surgery patients in Group 1 were applied sevoflurane (2-2.5%). Forty patients who underwent laparoscopic surgery were randomized into two groups. Anesthesia was maintained with sevoflurane (2-2.5%) in twenty patients in Group 2 and the TIVA technique in 20 patients in Group 3. In Group 1, PMEC was measured before anesthesia, 10 and 30 min after endotracheal intubation, 10 min before extubation, and 15, 30, 60 min and 6 hours in the postoperative period. In Group 2 and 3, PMEC was measured before the anesthesia, 10 min after intubation, 10 and 30 min after CO 2 insufflation, just before the CO 2 elimination, 10 min before the extubation, and 15, 30, 60 min and 6 hours after extubation in the postoperative period. Results. PMEC was significantly increased in Group 1 at 10 min after intubation, at 30 min of the operation, before extubation, and at postoperative 15 and 30 min (p < 0.05). In Group 3, differences between PMECs were detected at the 30 th min of insufflation (p = 0.005), and during elimination (p = 0.035) compared to the initial measurement. Generally, the values remained positive in Group 1 and negative in Group 3. There was a significant difference between Group 1 and Group 3 at 10 min after the induction (p = 0.001). There was no statistically significant difference in PMECs between Group 2 and 3 patients undergoing laparoscopic surgery. Conclusions. Our results indicate that, in laparoscopic surgery, TIVA used for the maintenance of anesthesia did not increase the PMEC and the changes caused by sevoflurane were also in the normal range of middle ear pressures. In patients with previous ear surgery, if there is a need of classical surgical procedures in the future, sevoflurane anesthesia should not be the first choice due to its effects on PMEC, which cause it to be increased over 50 daPa, especially at 30 min after intubation. Patient characteristics including previous ear surgery should be considered in selecting the optimum anesthetic agents and technique (Adv Clin Exp Med 2014, 23, 3, 447-454).

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Effect of nitrous oxide on middle ear pressure: a comparison between inhalational anaesthesia with nitrous oxide and TIVA

Cited by 28 publications

References 11 publications

A clinical trial of efficacy and safety of inhalation sedation with a 50% nitrous oxide/oxygen premix (Kalinox™) in general practice

A clinical trial of efficacy and safety of inhalation sedation with a 50% nitrous oxide/oxygen premix (Kalinox™) in general practice

Effects of sevoflurane and TIVA with propofol on middle ear pressure

Sevoflurane vs. TIVA in Terms of Middle Ear Pressure During Laparoscopic Surgery

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