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Nitrous oxide increases the incidence of bowel distension in patients undergoing elective colon resection
Author(s) -
AkÇa O.,
Lenhardt R.,
Fleischmann E.,
Treschan T.,
Greif R.,
Fleischhackl R.,
Kimberger O.,
Kurz A.,
Sessler D. I.
Publication year - 2004
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.0001-5172.2004.00427.x
Subject(s) - nitrous oxide , medicine , anesthesia , distension , nausea , vomiting , incidence (geometry) , gastroenterology , surgery , physics , optics
Background: Nitrous oxide rapidly inflates gas‐filled spaces such as the intestines; but whether the resulting bowel distension is clinically important remains unclear. We therefore tested the hypothesis that nitrous oxide produces clinically important bowel distension. Methods: Patients scheduled for colon resection were anesthetized with isoflurane and 35% oxygen and randomly assigned to 65% nitrous oxide ( n = 175) or 65% nitrogen in air ( n = 169). At the end of surgery, blinded surgeons rated the degree of bowel distension as none, mild, moderate, or severe. Patients reported pain, and nausea and vomiting (PONV) 2 h after surgery. Data are reported as means (SD). P < 0.05 was statistically significant. Results: Morphometric and demographic data were similar in the groups. The duration of surgery was 3.0 (1.2) h in the nitrous oxide group and 3.4 (1.5) h in the air group ( P = 0.017). Postoperative self‐reported pain scores (visual analog scale, 0–100 mm) were greater in the nitrous oxide group (43 [30] mm) than in the air group (35 [31] mm, P = 0.018). Although the incidence of PONV was similar in the groups, VAS scores for nausea were significantly greater in the nitrous oxide group ( P = 0.040). Moderate‐to‐severe bowel distension was observed in 23% of nitrous oxide patients, but in only 9% of patients in the air group ( P < 0.001). The number‐needed‐to‐harm for moderate or severe bowel distension from nitrous oxide was thus seven. Conclusions: Our results suggest that avoiding nitrous oxide administration during prolonged bowel operations will minimize bowel distension and possibly reduce postoperative pain related to it.