title: Magnitude of the second gas effect on arterial sevoflurane partial pressure.
abstract: BACKGROUND
  A number of studies have demonstrated a faster rate of increase in end-expired partial pressure as a fraction of inspired (Pa/Pi) for volatile agents in the presence of high concentrations of nitrous oxide, consistent with the second gas effect. However, no study has demonstrated a similar effect on arterial blood concentrations.
  
  
  METHODS
  The authors compared arterial and end-tidal partial pressures of sevoflurane (Pa/Pisevo and Pa/Pisevo) in 14 patients for 30 min after introduction of either 70% nitrous oxide or nitrous oxide-free gas mixtures to determine the magnitude of the second gas effect. Blood partial pressures were measured using a double headspace equilibration technique.
  
  
  RESULTS
  Both Pa/Pisevo and Pa/Pisevo were significantly higher in the nitrous oxide group than in the control group (P < 0.001 on two-way analysis of variance). This difference was significantly greater (P < 0.05) for Pa/Pisevo (23.6% higher in the nitrous oxide group at 2 min, declining to 12.5% at 30 min) than for Pa/Pisevo (9.8% higher in the nitrous oxide group at 2 min) and was accompanied by a significantly lower Bispectral Index score at 5 min (40.7 vs. 25.4; P = 0.004).
  
  
  CONCLUSIONS
  Nitrous oxide uptake exerts a significant second gas effect on arterial sevoflurane partial pressures. This effect is two to three times more powerful than the effect on end-expired partial pressures. The authors explain how this is due to the influence of ventilation-perfusion scatter on the distribution of blood flow and gas uptake in the lung.
authors.affiliation: Department of Anaesthesia, Austin Hospital, Heidelberg, Melbourne, Australia. phil.peyton@austin.org.au
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Peyton
authors.forename: Maryam
authors.initials: M
authors.lastname: Horriat
authors.forename: Gavin J B
authors.initials: GJ
authors.lastname: Robinson
authors.forename: Robert
authors.initials: R
authors.lastname: Pierce
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Thompson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000769:Anesthesia, Inhalation / Q000379:methods; D001784:Blood Gas Analysis / Q000379:methods; D002408:Catheters, Indwelling; D045853:Exhalation / Q000187:drug effects / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000097:blood*; D008875:Middle Aged; D009609:Nitrous Oxide / Q000097:blood* / Q000493:pharmacokinetics; D010313:Partial Pressure; D000077149:Sevoflurane
chemical_list: D008738:Methyl Ethers; D000077149:Sevoflurane; D009609:Nitrous Oxide