Middle ear pressure changes after nitrous oxide anesthesia and its effect on postoperative nausea and vomiting.
OBJECTIVE
This study was designed to explore the relationship between changes in middle ear pressure associated with inhalational anesthesia and the incidence of postoperative nausea and vomiting (PONV).


METHODS
Prospective, randomized.


METHODS
Middle ear compartment pressures were measured by tympanometry in 27 randomly assigned knee arthroscopy patients throughout the surgical procedure as well as into recovery.


RESULTS
A positive correlation between the maximum positive pressure (MPP) and maximum negative pressure (MNP) gradient and PONV was demonstrated (P <.05). The incidence of PONV in the nitrous oxide (N2O) treatment group was 6 of 16 patients, whereas only 2 of 11 patients in the control group developed nausea, vomiting, and vertigo symptoms. Those patients that did not experience PONV demonstrated a median MPP of 155 with a median MNP of -52. The patients that experienced PONV exhibited a median MPP of 179 with a median MNP of -164. This demonstrates a significant increase in the incidence of PONV in the N2O treatment group.


CONCLUSIONS
Barometric changes in the middle ear contribute to the incidence of PONV induced by N2O.
Nader
Nader D
ND
Department of Anesthesiology, Veteran's Administration, Western New York Healthcare Center, Buffalo, NY 14215, USA. nnader@buffalo.edu
Simpson
George
G
Reedy
Roberta L
RL
D000158:Acoustic Impedance Tests / Q000379:methods; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects*; D004432:Ear, Middle / Q000187:drug effects*; D006801:Humans; D009609:Nitrous Oxide / Q000009:adverse effects*; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced*; D011312:Pressure; D011446:Prospective Studies
D018712:Analgesics, Non-Narcotic; D009609:Nitrous Oxide