SDN members see fewer ads and full resolution images. Join our non-profit community!

Nitrous Oxide during Abdominal Surgery, Yay or Nay?

Discussion in 'Anesthesiology' started by 0kazak1, Sep 5, 2017.

  1. SDN is made possible through member donations, sponsorships, and our volunteers. Learn about SDN's nonprofit mission.
  1. 0kazak1

    0kazak1 ASA Member 7+ Year Member

    943
    280
    Nov 30, 2009
    OH
    I've thought about this and I can't seem to get a straight answer out of anyone. Obviously, you don't want to use nitrous in closed noncompliant spaces (middle ear and intracrainal cases), but what about using it during lap appy/choles, robo hys or during wake ups after a exlap/nephrectomy etc. How significant is the expansion effect for exposures less than 1 hour in duration?
     
  2. SDN Members don't see this ad. About the ads.
  3. pgg

    pgg Laugh at me, will they? SDN Moderator 10+ Year Member

    10,729
    4,713
    Dec 14, 2005
    Home Again
    It's fine. Maybe you get a bit more nausea. Maybe. I don't use much nitrous (inhalation inductions in healthy kids and GA sections) but I think the arguments against it are overblown.

    Someday I wish to visit this parallel universe where a robot hysterectomy is less than an all-day case ...
     
    dmk5n likes this.
  4. 0kazak1

    0kazak1 ASA Member 7+ Year Member

    943
    280
    Nov 30, 2009
    OH
    I had feelings it was overblown, but being so relatively new, and nervous about being too overconfident, I wasn't sure if it was an ignorance thing. One day the robot hysterectomies will not take all day, and one day they will also not only do them in large 250#+ patients.
     
  5. Ezekiel2517

    Ezekiel2517 Anesthesiologist 10+ Year Member

    451
    377
    Jan 21, 2005
    CA
    Physician
    hmm, robot hyst is a 1 hr case around my parts, sometimes 45 min
     
    VA Hopeful Dr, Wiscoblue and Twiggidy like this.
  6. Maverikk

    Maverikk ASA Member 2+ Year Member

    104
    21
    Jun 20, 2013
    It's an open space, it will be sucked out with excess CO2 that's used to insufflate if that's what you're thinking. The reasoning I've heard is to prevent bowel distension, which with small exposure times won't contribute
     
  7. FFP

    FFP Grunt, cog, body, pompous ass Gold Donor Classifieds Approved 10+ Year Member

    5,341
    4,286
    Oct 17, 2007
    the opposite pole
    I loooove nitrous, but I don't use it during laparoscopic cases. Why? Air embolism. I know it's rare, still I see at least one case every year. Without nitrous, the patient has a higher chances of surviving it intact. I may switch to nitrous once they are closing, but that's it.

    Even in open cases, if there is air in the bowel, nitrous can distend it more, so why bother. If present in nearby vessels, it replaces other gases pretty fast.
     
    Last edited: Sep 6, 2017
    GA8314 likes this.
  8. SaltyDog

    SaltyDog Keeping the Forces of Entropy at Bay 10+ Year Member

    1,941
    2,299
    Aug 10, 2007
    Closer to Mexico
    There's a theoretical risk of fire/combustion with a peritoneal cavity full of nitrous and a bovie. Can't say I've ever seen it, and don't really want to either. I bet it's pretty entertaining for a split second though.
     
    rakotomazoto and FFP like this.
  9. facted

    facted ASA Member 7+ Year Member

    481
    226
    Dec 15, 2008
    NYC
    I don't use nitrous during these cases. But once trocar's are out, I routinely use nitrous when they close for smooth wakeups and it's great. Interestingly, I have seen a few cases of significant bradycardia when I start it which might be from bowel insufflation leading to parasympathetic tone. Overall, I think it's perfectly safe at the end of a case.
     
  10. FFP

    FFP Grunt, cog, body, pompous ass Gold Donor Classifieds Approved 10+ Year Member

    5,341
    4,286
    Oct 17, 2007
    the opposite pole
    Agree. I once caught a CRNA using it during a lap chole. There were no problems (n=1).
     
  11. fakin' the funk

    fakin' the funk ASA Member 10+ Year Member

    2,469
    362
    Aug 23, 2004
    I used to use it all the time, with sevo, before I was at a place where there was desflurane. Surgeons don't complain, bowel's not distended (there are papers about blinding surgeons to nitrous/no nitrous and they can't tell), no fires, who knows if there's nausea. CO2 insufflation is continuously washing it out.
     
    okayplayer likes this.
  12. amyl

    amyl ASA Member 10+ Year Member

    I don't do it until they stop insufflation... reasons as above.
     
  13. zzsleepytinizz

    zzsleepytinizz 5+ Year Member

    18
    14
    Feb 20, 2011
    Nay. I personally don't like nitrous. Increases the risk of PONV, and is terrible for the environment. I do use it for emergency c-sections, and traumas though. We also started using it for labor at the hospital that I am currently working at. Patients seem somewhat happy with it as an alternative to epidurals.
     
  14. loveumms

    loveumms Senior Member 10+ Year Member

    664
    90
    Jul 8, 2005
    PA
    In residency I had a lap nephew Tony need open conversion because the bowel got so distended from nitrous (my then nitrous loving attending insisted we use it). Granted this was a few hours into a long nephew Tony but the bowel distentikn was significant.

    I personally do administer nitrous because I don't feel like it adds much to the anesthetic. Oh and it is terrible for the environment (when combined with des it is even worse).

    Nitrous stays in the atmosphere for 115 years.
     
  15. facted

    facted ASA Member 7+ Year Member

    481
    226
    Dec 15, 2008
    NYC
    In the Enigma II trial, the risk of nitrous induced nausea is basically zero if you use ANY anti-emetic prophylaxis. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60893-X/abstract

    Agree on the environmental effects, though I personally only use it for a few minutes at the end of a case to wash out the potent agents.
     
  16. GeorgiaPhDCRNA

    GeorgiaPhDCRNA Banned Banned Account on Hold

    5
    1
    Oct 8, 2017
    One of the attending I work with likes to do this, I'm not a fan for all the above mentioned reasons so I avoid it.
     
  17. facted

    facted ASA Member 7+ Year Member

    481
    226
    Dec 15, 2008
    NYC
    What are the above reasons? Other than environmental, none of the others are true.
     
  18. VA Hopeful Dr

    VA Hopeful Dr Senior Member 10+ Year Member

    12,214
    9,378
    Jul 28, 2004
    Physician
    Jeez, I hope you're at an academic center. The private OBs we worked with in residency usually took 60-75 minutes max.
     
  19. Psai

    Psai Account on Hold 2+ Year Member

    9,445
    18,554
    Jan 2, 2014
    ヽ(´ー`)ノ
    Physician
    Maybe they can teach our residents who routinely take 5 hours.
     
  20. VA Hopeful Dr

    VA Hopeful Dr Senior Member 10+ Year Member

    12,214
    9,378
    Jul 28, 2004
    Physician
    I would expect residence to take a long time, they are still learning after all.
     
  21. Psai

    Psai Account on Hold 2+ Year Member

    9,445
    18,554
    Jan 2, 2014
    ヽ(´ー`)ノ
    Physician
    If only they had that attitude towards anesthesiology trainees.
     
  22. VA Hopeful Dr

    VA Hopeful Dr Senior Member 10+ Year Member

    12,214
    9,378
    Jul 28, 2004
    Physician
    Shut up and lower the table!
     
  23. Psai

    Psai Account on Hold 2+ Year Member

    9,445
    18,554
    Jan 2, 2014
    ヽ(´ー`)ノ
    Physician
    Dawg I'm in charge of moving the table cause I'm the boss. They can only touch the controls when I say it's okay. No one ****s with my tube but me.
     
    VA Hopeful Dr likes this.
  24. zzsleepytinizz

    zzsleepytinizz 5+ Year Member

    18
    14
    Feb 20, 2011
    I say 'nay'! I only use nitrous for emergency cesarean sections, or hemodynamically unstable patients. It is terrible for the environment nd I don't really see any benefit.
     

Similar Threads
  1. llGSll K9
    Replies:
    5
    Views:
    1,458
  2. Anesdawg
    Replies:
    32
    Views:
    3,943
  3. Pewl
    Replies:
    3
    Views:
    1,711
  4. Dryacku
    Replies:
    54
    Views:
    5,252
  5. BLADEMDA
    Replies:
    45
    Views:
    5,577
Loading...

Share This Page