title: Impact of nitrous oxide on the haemodynamic consequences of venous carbon dioxide embolism: An experimental study.
abstract: BACKGROUND
  Nitrous oxide (N2O) is still considered an important component of general anaesthesia. However, should gas embolisation occur as result of carbon dioxide (CO2) pneumoperitoneum, N2O may compromise safety, as the consequences of a gas embolus consisting of a combination of CO2 and N2O may be more severe than CO2 alone.
  
  
  OBJECTIVE
  This experimental study was designed to compare the cardiopulmonary consequences of gas embolisation with a N2O/CO2 mixture, or CO2 alone.
  
  
  METHODS
  Experimental study.
  
  
  METHODS
  Research Institute Against Digestive Cancer laboratory, Strasbourg, France.
  
  
  METHODS
  Seven Large-White pigs receiving standardised inhalation anaesthesia.
  
  
  METHODS
  Each animal, acting as its own control, was studied in two successive experimental conditions - intravenous gas injections of 2 ml kg of 100% CO2 and 2 ml kg of a gas mixture consisting of 10% N2O and 90% CO2.
  
  
  METHODS
  Haemodynamic and ventilatory consequences of embolisation with the gases.
  
  
  RESULTS
  We found that the haemodynamic (heart rate, mean arterial blood pressure, central venous pressure, mean pulmonary artery pressure, pulmonary artery occlusion pressure and transoesophageal echocardiography parameters) and ventilatory (arterial oxygen saturation, end-tidal CO2 concentration and mixed venous oxygen saturation) consequences of embolisation with either 100% CO2 or 10% N2O with 90% CO2 were similar.
  
  
  CONCLUSIONS
  The findings of this study may alleviate concerns that the use of N2O, as a part of a balanced general anaesthesia technique, may have greater adverse consequences should embolisation of pneumoperitoneal gas containing N2O occur.
authors.affiliation: From the Service d'Anesthesie Reanimation Chirurgicale, Hopitaux Universitaires, Strasbourg, France (PAD, JP, EN); IRCAD-EITS, Strasbourg, France (MD); Laboratoire de Physiologie EA 3072, Faculté de médecine, Strasbourg, France (BG); and Department of Anesthesiology, and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, USA (GPJ).
authors.forename: Pierre A
authors.initials: PA
authors.lastname: Diemunsch
authors.forename: Eric
authors.initials: E
authors.lastname: Noll
authors.forename: Julien
authors.initials: J
authors.lastname: Pottecher
authors.forename: Michele
authors.initials: M
authors.lastname: Diana
authors.forename: Bernard
authors.initials: B
authors.lastname: Geny
authors.forename: Girish P
authors.initials: GP
authors.lastname: Joshi
mesh_terms: D000280:Administration, Inhalation; D018685:Anesthetics, Inhalation / Q000008:administration & dosage* / Q000633:toxicity; D000818:Animals; D002245:Carbon Dioxide; D004195:Disease Models, Animal; D004618:Embolism, Air / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D006439:Hemodynamics / Q000187:drug effects*; D009609:Nitrous Oxide / Q000008:administration & dosage* / Q000633:toxicity; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects*; D012123:Pulmonary Ventilation / Q000187:drug effects; D018570:Risk Assessment; D034421:Sus scrofa; D013997:Time Factors
chemical_list: D018685:Anesthetics, Inhalation; D002245:Carbon Dioxide; D009609:Nitrous Oxide