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However, in our opinion he neglects the often occurring dangerously increasing cuff pressures and its consequences. Daniel Sessler is not discussing the ongoing numerous deaths caused by pipeline construction flaws. He argues that N2O is inexpensive. But is this true? Is it really inexpensive? At least a subanalysis of the ENIGMA 1 trial with >2000 patients included, found an increase in total costs in the N2O group when compared with the costs of the N2O -free group (1). Daniel Sessler argues that postoperative nausea and vomiting are minor complications. However, in the ENIGMA II trial N2O caused an increase in PONV even in patients receiving PONV prophylaxis when compared with patients receiving N2O-free general anaesthesia without PONV prophylaxis (13.1 vs. 9.7%) (2). This article, which is co-authored by Daniel Sessler, concluded that severe PONV, which was observed in more than 10% of patients, was associated with postoperative fever, poor quality of recovery, and prolonged hospitalization.

Should we Still use Nitrous Oxide in our Clinical Practice? No! Rebuttal to Daniel Sessler “Pro Nitrous oxide”