Nitrous Oxide and Serious Morbidity and Mortality in the POISE Trial
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Key result
Nitrous oxide during non-cardiac surgery is not linked to increased risk of major cardiovascular events.
- OR 1.08
- 95% CI 0.82-1.44
- P=0.58
- n=5,133
Why the study?
Does nitrous oxide anesthesia increase the risk of cardiovascular death, nonfatal MI, and nonfatal cardiac arrest in patients undergoing surgery?
Population
5,133 patients from the POISE trial receiving general anesthesia
Comparison
Nitrous oxide anesthesia vs General anesthesia without nitrous oxide
Design
Cohort
Follow-up
30 days
Authors
Discussion
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Implication
Supports nitrous oxide safety in non-cardiac surgery; hypothesis-generating and requires randomized confirmation before practice change.
Study Design
Type
Cohort (n=5,133)
Multicenter
Yes
Structured PICO
Does nitrous oxide anesthesia increase the risk of cardiovascular death, nonfatal MI, and nonfatal cardiac arrest in patients undergoing surgery?
P
Population
5,133 patients aged 45 years or older with or at risk of ischemic heart disease undergoing non-cardiac surgery, followed for 30 days.
E
Exposure
Nitrous oxide anesthesia (coadministration of nitrous oxide in patients receiving general anesthesia, with or without additional neuraxial blockade or peripheral nerve blockade)
C
Comparator
General anesthesia without nitrous oxide
O
Outcome
Composite outcome of cardiovascular death, nonfatal myocardial infarction (MI), and nonfatal cardiac arrest within 30 days of randomizationcomposite
Main Result
Odds Ratio: 1.08 (95% CI 0.82–1.44)
Absolute Event Rate: 7.5% vs 6.9%
p-value: p=0.58
Nitrous oxide administration during general anesthesia was not associated with an increased risk of 30-day cardiovascular morbidity or mortality in patients from the POISE trial.
Limitations
- Observational nature of the data
- Lack of information on the concentration and duration of nitrous oxide administration
- observational nature of the data
- lack of information on the concentration and duration of nitrous oxide administration
Cite This Study
Leslie et al. (2013) conducted a cohort in Ischemic heart disease risk in non-cardiac surgery (n=5,133). Nitrous oxide vs. No nitrous oxide was evaluated on Composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal cardiac arrest within 30 days of randomization (OR 1.08, 95% CI 0.82-1.44, p=0.58). Nitrous oxide administration during non-cardiac surgery was not associated with an increased risk of cardiovascular death, non-fatal myocardial infarction, or non-fatal cardiac arrest (OR 1.08).
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