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December 1, 1990Anesthesia & Analgesia

No Finding of Increased Myocardial Ischemia During or After Carotid Endarterectomy Under Anesthesia With Nitrous Oxide

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Key result

Anesthesia including nitrous oxide did not increase intraoperative myocardial ischemia compared to oxygen alone (21% vs 44%; P=0.065) in patients undergoing carotid surgery.

Why the study?

Does an anesthetic regimen including nitrous oxide increase myocardial ischemia in patients undergoing carotid surgery?

Population

70 patients at risk for myocardial ischemia undergoing carotid endarterectomies or other carotid surgery.

Comparison

Anesthetic regimen including nitrous oxide… vs Anesthetic regimen excluding nitrous oxide…

Design

RCT, prospectively, randomly assigned

Follow-up

perioperative

Authors

SKSteven V. KozmaryU.S. National Science FoundationGLGeorge H. LampeU.S. National Science FoundationDBD. J. BenefielU.S. National Science Foundation

Discussion

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Implication

Nitrous oxide remains viable for carotid surgery anesthesia; extends RCT safety data on myocardial ischemia in vascular patients.

Study Design

Type

RCT (n=70)

Randomization

randomly assigned

Structured PICO

Does an anesthetic regimen including nitrous oxide increase myocardial ischemia in patients undergoing carotid surgery?

P
Population
70 patients at risk for myocardial ischemia undergoing carotid endarterectomy or other carotid surgery.
I
Intervention
Anesthetic regimen including nitrous oxide substituted for a portion of the anesthesia supplied by isoflurane.
C
Comparator
Anesthetic regimen excluding nitrous oxide, utilizing greater concentrations of oxygen and isoflurane.
O
Outcome
Intraoperative myocardial ischemia assessed by 12- or 5-lead electrocardiography or transesophageal echocardiography.safety

Main Result

Absolute Event Rate: 21% vs 44%

p-value: p=0.065

The use of nitrous oxide during carotid surgery does not appear to increase the risk of perioperative myocardial ischemia or infarction.

Cite This Study

Kozmary et al. (1990) conducted an RCT in Carotid surgery at risk for myocardial ischemia (n=70). Nitrous oxide vs. Oxygen and isoflurane was evaluated on Intraoperative myocardial ischemia by transesophageal echocardiographic or electrocardiographic criteria (p=0.065). Anesthesia including nitrous oxide did not increase intraoperative myocardial ischemia compared to oxygen alone (21% vs 44%; P=0.065) in patients undergoing carotid surgery.

synapsesocial.com/papers/6a9305f28fa104a887e9c8a7https://doi.org/10.1213/00000539-199012000-00003
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Nitrous Oxide Does Not Induce Myocardial Ischemia in Patients with Ischemic Heart Disease and Poor Ventricular Function1989 · 33 citations
  2. 2Nitrous Oxide-Induced Increased Homocysteine Concentrations Are Associated with Increased Postoperative Myocardial Ischemia in Patients Undergoing Carotid Endarterectomy2000 · 40 citations
  3. 3Nitrous Oxide-Induced Increased Homocysteine Concentrations Are Associated with Increased Postoperative Myocardial Ischemia in Patients Undergoing Carotid Endarterectomy2000 · 125 citations
  4. 4Addition of Nitrous Oxide to Fentanyl Anesthesia Does Not Induce Myocardial Ischemia in Patients with Ischemic Heart Disease1987 · 72 citations
  5. 5Clinical Pharmacology of Nitrous Oxide1990 · 76 citations