title: Homocysteine levels after nitrous oxide anesthesia for living-related donor renal transplantation: a randomized, controlled, double-blind study.
abstract: BACKGROUND
  Nitrous oxide anesthesia increases postoperative homocysteine concentrations. Renal transplantation candidates present with higher homocysteine levels than patients with no renal disease. We designed this study to investigate if homocysteine levels are higher in subjects receiving nitrous oxide for renal transplantation compared with subjects undergoing nitrous oxide free anesthesia.
  
  
  METHODS
  Data from 59 patients scheduled for living-related donor renal transplantation surgery were analyzed in this randomized, controlled, blinded, parallel-group, longitudinal trial. Patients were assigned to receive general anesthesia with (flowmeter was set at 2 L/min nitrous oxide and 1 L/min oxygen) or without nitrous oxide (2 L/min air and 1 L/min oxygen). We evaluated levels of total homocysteine and known determinants, including creatinine, folate, vitamin B12, albumin, and lipids. We evaluated factor V and von Willebrand factor (vWF) to determine endothelial dysfunction and creatinine kinase myocardial band (CKMB)-mass, troponin T to show myocardial ischemia preoperatively in the holding area (T1), after discontinuation of anesthetic gases (T2), and 24 hours after induction (T3).
  
  
  RESULTS
  Compared with baseline, homocysteine concentrations significantly decreased both in the nitrous oxide (22.3 ± 16.3 vs 11.8 ± 9.9; P < .00001) and nitrous oxide-free groups (21.5 ± 15.3 vs 8.0 ± 5.7; P < .0001) at postoperative hour 24. The nitrous oxide group had significantly higher mean plasma homocysteine concentrations than the nitrous oxide-free group (P = .021). The actual homocysteine difference between groups was 3.8 μmol/L.
  
  
  CONCLUSIONS
  This study shows that homocysteine levels markedly decrease within 24 hours after living-related donor kidney transplantation. Patients receiving nitrous oxide have a lesser reduction, but this finding is unlikely to have a clinical relevance.
authors: Anesthesiology and Reanimation Department, Antalya, Turkey. Electronic address: nesildgr@yahoo.com.
authors: N
authors: N
authors: Coskunfirat
authors: Anesthesiology and Reanimation Department, Antalya, Turkey.
authors: N
authors: N
authors: Hadimioglu
authors: Anesthesiology and Reanimation Department, Antalya, Turkey.
authors: Z
authors: Z
authors: Ertug
authors: Medical Biochemistry Department, Akdeniz University Hospital, Antalya, Turkey.
authors: H
authors: H
authors: Akbas
authors: Medical Biochemistry Department, Akdeniz University Hospital, Antalya, Turkey.
authors: F
authors: F
authors: Davran
authors: Antalya Education and Research, State Hospital, Antalya, Turkey.
authors: B
authors: B
authors: Ozdemir
authors: Biostatistics and Medical Informatics Department, Akdeniz University Medical School, Antalya, Turkey.
authors: A
authors: A
authors: Aktas Samur
authors: Anesthesiology and Reanimation Department, Antalya, Turkey.
authors: G
authors: G
authors: Arici
mesh_terms: D000328:Adult; D000768:Anesthesia, General; D018685:Anesthetics, Inhalation; D004311:Double-Blind Method; D005260:Female; D005492:Folic Acid / Q000097:blood; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000601:surgery; D016030:Kidney Transplantation; D019520:Living Donors; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009609:Nitrous Oxide; D011184:Postoperative Period; D011446:Prospective Studies
chemical_list: D018685:Anesthetics, Inhalation; D006710:Homocysteine; D005492:Folic Acid; D009609:Nitrous Oxide