Leukocyte DNA Damage and Wound Infection after Nitrous Oxide Administration

Chen, Yan; Liu, Xiao Dong; Chen, Cheng; Gin, Tony; Leslie, Kate; Myles, Paul S.; Chan, Matthew T. V.

doi:10.1097/aln.0b013e31829107b8

Cited by 46 publications

(53 citation statements)

References 48 publications

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“…2–6 This is of concern since nitrous oxide exposure for more than 2 hours has been reported to result in hematological changes in adults. 13,17,18 However, other reports found no hematological changes in adults after 3 to 10 hours of nitrous oxide exposure. 13,15,19 …”

Section: Discussionmentioning

confidence: 94%

The Hematological Effects of Nitrous Oxide Anesthesia in Pediatric Patients

Duma¹,

Cartmill

Blood

et al. 2015

Anesthesia &Amp; Analgesia

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Background Prolonged administration of nitrous oxide causes an increase in plasma homocysteine in children via vitamin B12 inactivation. However, it is unclear if nitrous oxide doses used in clinical practice cause adverse hematological effects in pediatric patients. Methods This retrospective study included 54 pediatric patients undergoing elective spinal surgery: 41 received nitrous oxide throughout anesthesia (maintenance group), 9 received nitrous oxide for induction and/or emergence (induction/emergence group), and 4 did not receive nitrous oxide (nitrous oxide-free group). Complete blood counts obtained before and up to 4 days after surgery were assessed for anemia, macro-/microcytosis, anisocytosis, hyper-/hypochromatosis, thrombocytopenia and leucopenia. The change (Δ) from preoperative to the highest postoperative value was calculated for mean corpuscular volume (MCV) and red cell distribution width (RDW). Results No pancytopenia was present in any patient after surgery. All patients had postoperative anemia; none had macrocytosis. Postoperative MCV (mean [99% CI]) peaked at 86 [85 to 88] fL, 85 [81 to 89] fL, and 88 [80 to 96] fL, and postoperative RDW at 13.2 [12.8 to 13.5] %, 13.3 [12.7 to 13.8] %, and 13.0 [11.4 to 14.6] % for the maintenance group, the induction/emergence group, and the nitrous oxide-free group. Two patients in the maintenance group (5 %) developed anisocytosis (RDW>14.6%), but none in the induction/emergence group or in the nitrous oxide-free group (P = 0.43). Both ΔMCV (P=0.52) and ΔRDW (P=0.16) were similar across all groups. Conclusions Nitrous oxide exposure for up to eight hours is not associated with megaloblastic anemia in pediatric patients undergoing major spinal surgery.

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Section: Discussionmentioning

confidence: 94%

The Hematological Effects of Nitrous Oxide Anesthesia in Pediatric Patients

Duma¹,

Cartmill

Blood

et al. 2015

Anesthesia &Amp; Analgesia

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“…50,51 Genotoxicity and teratogenicity An ex-vivo assessment of DNA damage in patients exposed to high concentrations of N 2 O during colorectal surgery showed increased genotoxicity compared with controls. 52 The clinical significance of the finding is unclear. 53 N 2 O is fetotoxic in pregnant rats, 54 and crosses the human placenta.…”

Section: Gastrointestinal Effectsmentioning

confidence: 97%

The adverse effects of nitrous oxide

Ferner

Mackenzie²,

Aronson³

2014

Adverse Drug Reaction Bulletin

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“…Recent years' evidence has questioned the use of N 2 O on several potential or actual negative actions, namely: Inhibition of methionine synthetase (inactivation B12 vitamin) [13], increase closed spaces volume and pressure [14], reduce protein synthesis promoting surgical site infection [15,16], increase vascular risk in perioperative period [17], increase in PONV [16], and a contribution to degradation of ozone layer as a greenhouse effect gas [18].…”

Section: Nitrous Oxidementioning

confidence: 99%

“…In addition, no evidence exists that recommends, without any doubt, its discontinuation and, most importantly, health professionals are not at risk when N 2 O is used in modern, state of the art operating rooms with adequate scavenging systems [4,24]. Table 2 Decreases hyperalgesia of opioids [2,23] Inhibition of methionine synthetase [13] Decreases chronic postsurgical pain [23] Increase bowel volume and pressure in closed spaces [14] Good vehicle of volatiles (less dose) [24] Reduce protein synthesis promoting surgical site infection [15,16] Similar infection rate [13,19] Increased vascular risk in perioperative period [17] No increase in cardiovascular effects [20,19] Increase PONV [16] Small increase (resolved with one anti-emetic)…”

Section: Nitrous Oxidementioning

confidence: 99%

O2 and N2O: Between the Rock and the Hard Place

Machado¹

2016

J Anesth Clin Res

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The use of oxygen and nitrous oxide is part of anesthetic practice since ever. These gases follow anesthetic practice in almost all types of clinical settings, procedures and patients. Their indications and limitations of use are well known.In recent years a great debate either in literature or in scientific meetings has been addressed, concerning the potential poor outcomes related to the use of certain amounts of oxygen and the use of nitrous oxide.The objective of this review is to gather information related to these two topics, based on the recent most relevant publications (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016).Results show that both drugs have its advantages and drawbacks, and it is the clinical objective, the procedure, and the type of patient that will contribute the most for the anesthesiologist final decision.As a conclusion it was found that, 1) oxygen is a lifesaving drug on one side, but its use should be judicious since its high inspired fraction may have direct implications on that lung wellbeing, and 2) nitrous oxide has its known contraindications that should be taken into consideration and preclude its use when not clinically appropriate, however no evidence exists that indicates a formal discontinuation of its use, and in certain clinical scenarios it can be of relevant utility.

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Leukocyte DNA Damage and Wound Infection after Nitrous Oxide Administration

Abstract: Nitrous oxide increased DNA damage compared with nitrous oxide-free anesthesia and was associated with postoperative wound infection.

Cited by 46 publications

References 48 publications

The Hematological Effects of Nitrous Oxide Anesthesia in Pediatric Patients

The Hematological Effects of Nitrous Oxide Anesthesia in Pediatric Patients

The adverse effects of nitrous oxide

O2 and N2O: Between the Rock and the Hard Place

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