1. It’s Test Prep Week! Visit the Test Prep Forums to learn about test prep products and services, ask questions in test-related AMA threads, take advantage of exclusive SDN member discounts, and enter to win free stuff!
Whether you’re preparing for the USMLE, COMLEX, NBDE or APMLE, Test Prep Week Exhibitors can help you ace your boards!

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

    909
    239
    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

    10,526
    4,372
    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

    909
    239
    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

    416
    327
    Jan 21, 2005
    CA
    Physician
    hmm, robot hyst is a 1 hr case around my parts, sometimes 45 min
     
    Wiscoblue and Twiggidy like this.
  6. Maverikk

    Maverikk 2+ Year Member

    92
    11
    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 7+ Year Member

    5,135
    4,005
    Oct 17, 2007
    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
  8. SaltyDog

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

    1,814
    2,030
    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

    373
    150
    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 7+ Year Member

    5,135
    4,005
    Oct 17, 2007
    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

    2,447
    337
    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.
     

Similar Threads
  1. llGSll K9
    Replies:
    5
    Views:
    1,435
  2. Anesdawg
    Replies:
    32
    Views:
    3,902
  3. Pewl
    Replies:
    3
    Views:
    1,687
  4. Dryacku
    Replies:
    54
    Views:
    5,219
  5. BLADEMDA
    Replies:
    45
    Views:
    5,523
Loading...

Share This Page