Nitrous oxide in pediatric anesthesia: friend or foe?

Schmitt, Erica L; Baum, Victor C.

doi:10.1097/aco.0b013e3282f8ad76

Cited by 18 publications

(6 citation statements)

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“…Despite its long history, there have been increasing concerns 8 of its possible adverse effects on both patients 9 10 and the environment. 11 12 More recently, it has been implicated in contributing to increased postoperative nausea/ vomiting, pulmonary complications, 9 and possibly apoptosis in the developing brain 13 (in animal studies). Previously associated with increased spontaneous abortions in the prescavenging era, 14 it is still considered a potential health hazard to healthcare staff, as prolonged exposure may have repercussions on the reproductive, neurological, and haematological systems, by inhibition of methionine synthesis.…”

Section: Accepted For Publication: 23 July 2012mentioning

confidence: 99%

Single-breath vital capacity high concentration sevoflurane induction in children: with or without nitrous oxide?

Lee

Cheng

et al. 2013

British Journal of Anaesthesia

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Section: Accepted For Publication: 23 July 2012mentioning

confidence: 99%

Single-breath vital capacity high concentration sevoflurane induction in children: with or without nitrous oxide?

Lee

Cheng

et al. 2013

British Journal of Anaesthesia

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“…3,4 Is this simply a biochemical aberration without clinical relevance or indicator, perhaps even cause, of important clinical outcomes? 5,6 …”

Section: Introductionmentioning

confidence: 99%

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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“…5 Although such approaches were developed at a time of limited availability of anesthetic agents, this practice -thankfully -differs dramatically from our current approach. These days, we often advocate the avoidance of nitrous oxide, 6,7 and pre-oxygenation is advocated routinely as one means to prevent hypoxemia. The large database of the current study helps us to appreciate further the frequency and risks of perioperative hypoxia, moving us forward from the days of ''black gas anesthesia''.…”

mentioning

confidence: 99%