November 1, 2000Anesthesia & Analgesia
Nitrous Oxide-Induced Increased Homocysteine Concentrations Are Associated with Increased Postoperative Myocardial Ischemia in Patients Undergoing Carotid Endarterectomy
Why the study?
Does general anesthesia with nitrous oxide increase postoperative myocardial ischemia and homocysteine levels in patients undergoing carotid endarterectomy?
Population
90 ASA Class I-III patients presenting for elective carotid endarterectomy
Comparison
General anesthesia with nitrous oxide vs General anesthesia without nitrous oxide
Design
RCT, randomized
Follow-up
48 hours
Authors
Discussion
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Member takes
Implication
Avoid nitrous oxide in carotid endarterectomy; confirms homocysteine elevation promotes postoperative myocardial ischemia.
Key Points
- This research aims to explore the relationship between nitrous oxide anesthesia, homocysteine levels, and myocardial ischemia during carotid endarterectomy.
- Prospective, randomized study with 90 ASA Class I-III patients undergoing elective carotid endarterectomy.
- Patients received general anesthesia with or without nitrous oxide, with blood samples taken for homocysteine analysis at various intervals.
- Monitoring for myocardial ischemia was performed using a three-channel, seven-lead Holter monitor for 48 hours postoperatively.
- The nitrous oxide group exhibited significantly higher plasma homocysteine levels (15.5 +/- 5.9 and 18.8 +/- 14.7 micromol/L) compared to the nonnitrous group (11.4 +/- 5.2 and 11.3 +/- 4.0) with P < 0.001.
- Increased incidence of ischemia in the nitrous oxide group was observed (46% vs. 25%, P < 0.05) along with greater duration of ischemic events.
- More ischemic events were recorded in the nitrous oxide group (82 vs. 53, P < 0.02), with significantly longer ischemia lasting over 30 minutes (23 vs. 14, P < 0.05).
Structured PICO
Does general anesthesia with nitrous oxide increase postoperative myocardial ischemia and homocysteine levels in patients undergoing carotid endarterectomy?
P
Population
90 ASA Class I-III patients presenting for elective carotid endarterectomy
I
Intervention
General anesthesia with nitrous oxide
C
Comparator
General anesthesia without nitrous oxide
O
Outcome
Postoperative myocardial ischemia (monitored by Holter) and plasma homocysteine levels at 48 hourssurrogate
The use of nitrous oxide during carotid endarterectomy increases postoperative plasma homocysteine levels and the incidence of myocardial ischemia.
Cite This Study
Badner et al. (2000) studied this question.