Synapse
⌘+K
Synapse
PulseExploreClubsResearchersJournals
Instagram
HomeClubsExplore
December 1, 1987Anesthesiology

Addition of Nitrous Oxide to Fentanyl Anesthesia Does Not Induce Myocardial Ischemia in Patients with Ischemic Heart Disease

View Full Paper
Ask AI
Bookmark
Share

Key result

Addition of 60% nitrous oxide to fentanyl anesthesia did not induce myocardial ischemia (0% ST segment changes or new wall motion abnormalities) compared to 60% nitrogen in patients requiring CABG.

Why the study?

Does the addition of nitrous oxide to fentanyl anesthesia induce myocardial ischemia in patients with severe coronary artery disease requiring CABG?

Population

18 patients with severe coronary-artery disease requiring coronary-artery bypass grafting, with…

Comparison

60% nitrous oxide added to the inspired gas… vs 60% nitrogen added to the inspired gas mixture…

Design

RCT, randomly assigned crossover order

Follow-up

10 minutes per gas mixture

Authors

MCMichael K. CahalanJikei University School of MedicineOPOmar PrakashUniversity of UtahEREvert N. R. RulfUniversity of San Diego

Discussion

Loading...

Member takes

Implication

Supports nitrous oxide addition to fentanyl anesthesia in CABG; confirms no ischemia induction in preserved LV function.

Key Points

  • To assess whether adding nitrous oxide to fentanyl anesthesia precipitates myocardial ischemia or regional ventricular dysfunction in patients with severe ischemic heart disease.
  • Conducted a randomized crossover trial in 18 patients scheduled for coronary-artery bypass grafting with normal valvular and left ventricular function under intravenous fentanyl anesthesia.
  • Administered 60% nitrous oxide or 60% nitrogen in randomly assigned sequences for 10 minutes each, separated by a 10-minute washout with 100% oxygen prior to surgery.
  • Monitored cardiac effects continuously using 12-lead electrocardiography for ST-segment deviation and transesophageal two-dimensional echocardiography for segmental wall motion abnormalities.
  • No patient (0 of 18) exhibited an ST-segment change greater than 1 mm during inhalation of either nitrous oxide or nitrogen.
  • No new segmental left ventricular wall motion abnormalities developed during the administration of either test gas.

Study Design

Type

RCT (n=18)

Randomization

randomly assigned

Structured PICO

Does the addition of nitrous oxide to fentanyl anesthesia induce myocardial ischemia in patients with severe coronary artery disease requiring CABG?

P
Population
18 patients with severe coronary-artery disease requiring coronary-artery bypass grafting, with well-preserved valvular and left ventricular function.
I
Intervention
60% nitrous oxide added to the inspired gas mixture for 10 minutes during intravenous fentanyl anesthesia
C
Comparator
60% nitrogen added to the inspired gas mixture for 10 minutes during intravenous fentanyl anesthesia (crossover design)
O
Outcome
Myocardial ischemia assessed by ST segment changes on a standard 12-lead electrocardiogram and segmental wall motion abnormalities on trans-esophageal two-dimensional echocardiographysurrogate

Main Result

Absolute Event Rate: 0% vs 0%

The addition of nitrous oxide to fentanyl anesthesia does not induce myocardial ischemia in patients with severe coronary artery disease and preserved LV function undergoing CABG.

Cite This Study

Cahalan et al. (1987) conducted an RCT in ischemic heart disease (n=18). Nitrous oxide vs. 60% nitrogen was evaluated on Myocardial ischemia (ST segment change greater than 1 mm or new segmental wall motion abnormality). Addition of 60% nitrous oxide to fentanyl anesthesia did not induce myocardial ischemia (0% ST segment changes or new wall motion abnormalities) compared to 60% nitrogen in patients requiring CABG.

synapsesocial.com/papers/6a9305f28fa104a887e9c8abhttps://doi.org/10.1097/00000542-198712000-00008
View Full Paper
Ask AI
Bookmark
Share

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. 2The Effects of Nitrous Oxide on Myocardial Metabolism and Hemodynamics during Fentanyl or Enflurane Anesthesia in Patients with Coronary Disease1984 · 58 citations
  3. 3Anaesthesia for abdominal aortic surgery in patients with coronary artery disease, part II: effects of nitrous oxide on systemic and coronary haemodynamics, regional ventricular function and incidence of myocardial ischaemia1994 · 25 citations
  4. 4Haemodynamic Response to Nitrous Oxide during High‐Dose Fentanyl Pancuronium Anaesthesia1985 · 11 citations
  5. 5Roles of Fentanyl and Nitroglycerin in Prevention of Myocardial Ischemia Associated with Laryngoscopy and Tracheal Intubation in Patients Undergoing Operations of Short Duration1986 · 25 citations