October 1, 2008Open Access
Effect of Nitrous Oxide Anesthesia on Plasma Homocysteine and Endothelial Function
Key Result
Nitrous oxide-based anesthesia significantly increased postoperative homocysteine and decreased flow-mediated dilation (mean difference 3.2%; 95% CI 0.1-5.3%; P=0.001) compared to control.
Study Design
Type
RCT (n=59)
Randomization
randomly allocated
Structured PICO
Does nitrous oxide-based anesthesia impair endothelial function in patients with cardiovascular disease undergoing noncardiac surgery?
P
Population
59 patients with cardiovascular disease undergoing noncardiac surgery
I
Intervention
Nitrous oxide-based anesthesia
C
Comparator
Nitrous oxide-free anesthesia
O
Outcome
Endothelial function measured by flow-mediated dilation of the brachial artery before and 24 h after surgerysurrogate
Nitrous oxide-based anesthesia increases plasma homocysteine and impairs endothelial function in patients with cardiovascular disease undergoing noncardiac surgery, potentially increasing postoperative cardiovascular risk.
Main Result
Effect estimate: mean difference 3.2% (95% CI 0.1-5.3%)
p-value: p=0.001
Abstract
BACKGROUND: Endothelial function is impaired with hyperhomocysteinemia. Plasma homocysteine is increased by nitrous oxide anesthesia. The current study was designed to determine whether endothelial function is impaired after surgery and whether this is made worse by exposure to nitrous oxide. METHODS: The authors studied 59 patients with cardiovascular disease undergoing noncardiac surgery. Patients were randomly allocated to nitrous oxide-based anesthesia (n = 25) or nitrous oxide-free anesthesia (control, n = 34). Endothelial function was measured by flow-mediated dilation of the brachial artery before and 24 h after surgery. In addition, blood was drawn at both time points for the measurements of plasma homocysteine, folate, L-arginine, L-citrulline, asymmetric dimethylarginine, and nitrate concentrations. RESULTS: The median duration of general anesthesia was 4.5 h. Patients had significantly lower flow-mediated dilation after surgery (5.1 +/- 3.3 to 3.0 +/- 4.1%; P = 0.001). Duration of anesthesia affected endothelial function. In the nitrous oxide group, there was an inverse correlation with flow-mediated dilation (r = -0.60, P = 0.004), but in the control group, there was a positive correlation (r = 0.61, P < 0.001). When compared with control, nitrous oxide exposure was associated with a significant increase in postoperative homocysteine (mean difference, 4.9 microm; 95% confidence interval, 2.8-7.0 microm; P < 0.0005) and decrease in flow-mediated dilation (3.2%; 95% confidence interval, 0.1-5.3%; P = 0.001). Nitrous oxide exposure was not associated with change in nitric oxide substrates. CONCLUSIONS: Nitrous oxide-based anesthesia increased plasma homocysteine and significantly impaired endothelial function in patients undergoing noncardiac surgery. Nitrous oxide-based anesthesia could be a risk factor for postoperative cardiovascular morbidity.