Nitrous oxide-based versus nitrous oxide-free general anaesthesia and accidental awareness during general anaesthesia in surgical patients

Hounsome, Juliet; Nicholson, Amanda; Greenhalgh, J; Cook, Tim; Smith, Andrew F.; Lewis, Sharon R

doi:10.1002/14651858.cd011052.pub2

Cited by 7 publications

(4 citation statements)

References 79 publications

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“…Inadequate glottic view accounted for 17 of 23 instances in which patients did not receive the intended intervention . Prior studies have indicated that difficulty, multiple attempts, or delay during tracheal intubation underpin many cases of airway misadventure, and systematic review indicates that video laryngoscopy improves ease and success of tracheal intubation, particularly if there is anatomical difficulty . The present study reinforces the vital importance of glottic visualization and the value of video laryngoscopy.…”

supporting

confidence: 62%

Use of a Bougie vs Endotracheal Tube With Stylet and Successful Intubation on the First Attempt Among Critically Ill Patients Undergoing Tracheal Intubation

Brenner

McGrath

Cook

2022

JAMA

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supporting

confidence: 62%

Use of a Bougie vs Endotracheal Tube With Stylet and Successful Intubation on the First Attempt Among Critically Ill Patients Undergoing Tracheal Intubation

Brenner

McGrath

Cook

2022

JAMA

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“…TIVA has been identified as a risk for intraoperative awareness and could contribute to a delayed emergence due to the inability to monitor plasma levels after its termination . Although it has been suggested that the inclusion of N 2 O reduces the incidence of intraoperative awareness, a recent Cochrane review could not conclusively corroborate those data . However, the ability to monitor an expired end tidal anesthetic concentration of 70% minimum alveolar concentration (MAC) was superior compared to Bispectral Index (BIS) monitoring to reduce intraoperative awareness .…”

Section: Discussionmentioning

confidence: 99%

Nitrous oxide anesthetic versus total intravenous anesthesia for functional endoscopic sinus surgery

et al. 2019

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Background: Functional endoscopic sinus surgery is a common procedure for sinonasal disease, frequently performed in the outpatient setting. General anesthesia maintained with total intravenous anesthesia (TIVA) with propofol has been shown to give superior surgical conditions compared to inhaled anesthetics. This study evaluated the effects of TIVA versus a predominantly nitrous oxide (N 2 O)-based anesthetic with a low-dose propofol and remifentanil infusion on sinus surgery.Methods: Patients were randomized to either a N 2 O-based (nitrous oxide with propofol and remifentanil) or TIVA (propofol and remifentanil without nitrous oxide) group. The surgeon was blinded to the anesthetic technique. Surgical field grading was performed in real time by the otolaryngologist every 15 minutes with the Boezaart grading system.Results: There were no statistically significant differences between the Boezaart scores, duration of surgery, or estimated blood loss between the two anesthetic techniques. However, the use of N 2 O provided a statistically significant, 38% reduction in time from surgery end to extubation. The TIVA group had significantly decreased mean and median pain scores in the post-anesthesia care unit (PACU). There was no difference in the rate of postoperative nausea and vomiting between the two groups.Conclusion: A N 2 O-based anesthetic for functional endoscopic sinus surgery provides similar intraoperative and postoperative conditions when compared to TIVA, while being superior in terms of time to extubation. Although the TIVA group had significantly decreased pain scores, this did not lead to a decrease in pain medicine received in the PACU, and there was no difference between groups in time to discharge.

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“…A protocol for conducting this systematic review and the full published review are available elsewhere. We considered all RCTs including quasi‐randomised studies and cluster‐randomised studies.…”

Section: Methodsmentioning

confidence: 99%

Nitrous oxide‐based vs. nitrous oxide‐free general anaesthesia and accidental awareness in surgical patients: an abridged Cochrane systematic review

et al. 2017

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Summary Accidental awareness during general anaesthesia can arise from a failure to deliver sufficient anaesthetic agent, or from a patient's resistance to an expected sufficient dose of such an agent. Awareness is ‘explicit’ if the patient is subsequently able to recall the event. We conducted a systematic review into the effect of nitrous oxide used as part of a general anaesthetic on the risk of accidental awareness in people over the age of five years undergoing general anaesthesia for surgery. We included 15 randomised controlled trials, 14 of which, representing a total of 3439 participants, were included in our primary analysis of the frequency of accidental awareness events. The awareness incidence rate was rare within these studies, and all were considered underpowered with respect to this outcome. The risk of bias across all studies was judged to be high, and 76% of studies failed adequately to conceal participant allocation. We considered the available evidence to be of very poor quality. There were a total of three accidental awareness events reported in two studies, one of which reported that the awareness was the result of a kink in a propofol intravenous line. There were insufficient data to conduct a meta‐ or sub‐group analysis and there was insufficient evidence to draw outcome‐related conclusions. We can, however, recommend that future studies focus on potentially high‐risk groups such as obstetric or cardiac surgery patients, or those receiving neuromuscular blocking drugs or total intravenous anaesthesia.

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Nitrous oxide-based versus nitrous oxide-free general anaesthesia and accidental awareness during general anaesthesia in surgical patients

Cited by 7 publications

References 79 publications

Use of a Bougie vs Endotracheal Tube With Stylet and Successful Intubation on the First Attempt Among Critically Ill Patients Undergoing Tracheal Intubation

Use of a Bougie vs Endotracheal Tube With Stylet and Successful Intubation on the First Attempt Among Critically Ill Patients Undergoing Tracheal Intubation

Nitrous oxide anesthetic versus total intravenous anesthesia for functional endoscopic sinus surgery

Nitrous oxide‐based vs. nitrous oxide‐free general anaesthesia and accidental awareness in surgical patients: an abridged Cochrane systematic review

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