[Cervical myelopathy secondary to recreational nitrous oxide use: an emergent pathology]. / Mielopatía cervical secundaria al consumo recreativo de óxido nitroso. Una afección emergente.

We describe the case of a 27-year-old female patient who presented to the emergency ward with hypoesthesia and paresthesia developing over the last two months, initially in both feet and progressing to the knees in a few days without associated gait disorders. Dystonia in the thumb and index finger of both hands was noted. Blood tests including toxic drugs were negative. The spinal magnetic resonance imaging was consistent with (C3-C5) myelopathy or myelitis without other abnormalities suggestive of systemic diseases. The biochemical and bacteriological analysis of the cerebrospinal fluid was normal. Because of these findings, the patient was re-interviewed to determine the consumption of unusual drugs, and nitrous oxide consumption was referred. The patient was admitted for further studies, which confirmed the diagnosis.

Se describe el caso de una paciente de 27 años que se presentó al servicio de urgencias por hipoestesia y parestesia de dos meses de evolución. El cuadro se inició en ambos pies, progresó en pocos días hasta las rodillas sin trastornos de la marcha y se acompañó de distonías en pulgar e índice de ambas manos. La analítica sanguínea incluyendo tóxicos fue negativa. La resonancia magnética medular mostró una imagen sugestiva de mielopatía o mielitis (C3-C5) sin otras anomalías sugestivas de enfermedad sistémica. El análisis bioquímico y el bacteriológico del líquido cefalorraquídeo fueron normales. Ante estos elementos se re-interrogó a la paciente en busca de consumo de tóxicos inusuales con la confirmación de consumo de óxido nitroso. La paciente fue internada para la realización de otros estudios que confirmaron la hipótesis diagnóstica del servicio de urgencias.

Mielopatía cervical secundaria al consumo recreativo de óxido nitroso una afección emergente / Cervical myelopathy secondary to recreational nitrous oxide use: an emergent pathology

Resumen Se describe el caso de una paciente de 27 años que se presentó al servicio de urgencias por hipoestesia y parestesia de dos meses de evolución. El cuadro se inició en ambos pies, progresó en pocos días hasta las rodillas sin trastornos de la marcha y se acompañó de distonías en pulgar e índice de ambas manos. La analítica sanguínea incluyendo tóxicos fue negativa. La resonancia magnética medular mostró una imagen sugestiva de mielopatía o mielitis (C3-C5) sin otras anomalías sugestivas de enfermedad sistémica. El análisis bioquímico y el bacteriológico del líquido cefalorraquídeo fueron normales. Ante estos elementos se re-interrogó a la paciente en busca de consumo de tóxicos inusuales con la confirmación de consumo de óxido nitroso. La paciente fue internada para la realización de otros estudios que confirmaron la hipótesis diagnóstica del servicio de urgencias.

Abstract We describe the case of a 27-year-old female patient who presented to the emergency ward with hypoesthesia and paresthesia developing over the last two months, initially in both feet and progressing to the knees in a few days without associated gait disorders. Dystonia in the thumb and index finger of both hands was noted. Blood tests including toxic drugs were negative. The spinal magnetic resonance imaging was consistent with (C3-C5) myelopathy or myelitis without other abnormalities suggestive of systemic diseases. The biochemi cal and bacteriological analysis of the cerebrospinal fluid was normal. Because of these findings, the patient was re-interviewed to determine the consumption of unusual drugs, and nitrous oxide consumption was referred. The patient was admitted for further studies, which confirmed the diagnosis.

Oxidative stress, DNA damage, inflammation and gene expression in occupationally exposed university hospital anesthesia providers.

Considering the importance and lack of data of toxicogenomic approaches on occupational exposure to anesthetics, we evaluated possible associations between waste anesthetic gases (WAGs) exposure and biological effects including oxidative stress, DNA damage, inflammation, and transcriptional modulation. The exposed group was constituted by anesthesia providers who were mainly exposed to the anesthetics sevoflurane and isoflurane (10 ppm) and to a lesser degree to nitrous oxide (150 ppm), and the control group was constituted by physicians who had no exposure to WAGs. The oxidative stress markers included oxidized DNA bases (comet assay), malondialdehyde (high-performance liquid chromatography [HPLC]), nitric oxide metabolites (ozone-chemiluminescence), and antioxidative markers, including individual antioxidants (HPLC) and antioxidant defense marker (ferric reducing antioxidant power by spectrophotometry). The inflammatory markers included high-sensitivity C-reactive protein (chemiluminescent immunoassay) and the proinflammatory interleukins IL-6, IL-8 and IL-17A (flow cytometry). Telomere length and gene expression related to DNA repair (hOGG1 and XRCC1), antioxidant defense (NRF2) and inflammation (IL6, IL8 and IL17A) were evaluated by real-time quantitative polymerase chain reaction. No significant differences (p > .0025) between the groups were observed for any parameter evaluated. Thus, under the conditions of the study, the findings suggest that occupational exposure to WAGs is not associated with oxidative stress or inflammation when evaluated in serum/plasma, with DNA damage evaluated in lymphocytes and leucocytes or with molecular modulation assessed in peripheral blood cells in university anesthesia providers. However, it is prudent to reduce WAGs exposure and to increase biomonitoring of all occupationally exposed professionals.

Gene and systemic inflammatory effects and neuroendocrine response in surgical patients anesthetized with desflurane-nitrous oxide or desflurane-nitrous oxide-free: A randomized trial.

There is growing interest in assessing possible immunotoxicological effects in anesthetized patients. There are controversial findings concerning the effect of nitrous oxide (N2O) anesthetic gas effect on inflammatory response. We tested the hypothesis that N2O associated with desflurane (inhalational anesthetic) was likely to worsen neuro-immune-endocrine effects when compared with desflurane alone in this randomized trial. The primary endpoint of this study was to evaluate the systemic proinflammatory interleukin (IL)-6, and the secondary endpoints included other systemic (IL-1ß, TNF-α, IL-8, IL-10, IL-17A and high-sensitivity C-reactive protein - hs-CRP) and genetic inflammatory markers (NF-kB, IL-6 and COX-2) as well as hormones (adrenocorticotropic hormone, cortisol and prolactin) comparing patients undergoing minor surgery with or without N2O-desflurane. As a second aim, we assessed whether there were changes in the neuro-immune-endocrine profiles within each group. Blood samples were collected before anesthesia, 90 min after anesthesia induction, and the day after surgery. We assessed serum cytokines using a cytometric bead array and hs-CRP by chemiluminescent immunoassay. Expression of three proinflammatory transcripts was assessed by real-time quantitative polymerase chain reaction, and neuroendocrine hormones were detected by chemiluminescent microparticle immunoenzymatic assay. There were no significant between-group differences for any analyzed biomarkers. However, there was a significant increase in: (a) systemic IL-6 and hs-CRP values one day after surgery in both groups and (b) prolactin levels in the intraoperative period compared to baseline and postoperative period levels for both groups. In conclusion, N2O does not impair the inflammatory profile and neuroendocrine response compared to patients who receive only desflurane anesthesia.

Energy efficiency and emissions of CO2, CH4, and N2O in organic and conventional rice production / Eficiência energética e emissões de CO2, CH4 e N2O em arroz sob cultivo orgânico e convencional

Rice is the second-most produced cereal worldwide and actively contributes to greenhouse gas (GHG) emissions, particularly methane, especially under deepwater production. Assessments of energy efficiency (EE) and GHG emissions can indicate the sustainability level of agrosystems and support decisions related to the reduction of production costs and environmental pollution. This study aimed to assess both EE and GHG emissions in organic and conventional rice production in the Southern region of Brazil. For this study, eight rice fields were evaluated. Energy inputs and outputs were calculated by multiplying the production input amounts by their respective calorific values or energy coefficients at each stage of production. EE was determined using the ratio between the total energy output and the total energy consumed during the production process. GHG emissions were estimated using the principles of the lifecycle assessment methodology in addition to the Intergovernmental Panel on Climate Change (IPCC) recommendations. Each 1.0 MJ consumed during the production of organic and conventional rice produced renewable energy averages of 10.5 MJ and 7.90 MJ, respectively, as grains. The primary energy expenses for organic rice were represented by seeds, fuel, tractors, and agricultural machinery and implements, and those for conventional rice were seeds, fuel, and fertilizers. Each kilogram of organic and conventional rice produced accounted for the emission of 0.21 and 0.32 kg of CO2eq, respectively, during the production cycles and delivery to the warehouse, with seeds, fuel, and fertilizers being the main sources of CO2eq emissions to the atmosphere.(AU)

O arroz é o segundo cereal mais cultivado no mundo e contribui ativamente nas emissões de GEE, principalmente em áreas produzidas sob inundação, com destaque para a produção de gás metano. A eficiência energética (EE) e as emissões de gases de efeito estufa (GEE) podem indicar o nível de sustentabilidade dos agrossistemas e a tomada de decisões relativas à redução dos custos de produção e poluição do ambiente. O objetivo deste trabalho foi avaliar a EE e emissões de GEE nas culturas do arroz sob cultivo orgânico e convencional na região sul do Brasil. Para isso, foram avaliadas oito áreas de arroz. As entradas e saídas de energia foram calculadas pela multiplicação da quantidade de produtos utilizados para a produção de arroz pelos seus respectivos poderes caloríficos ou coeficientes energéticos em cada etapa de produção. A EE foi obtida pela razão entre a quantidade de energia total de saída e o consumo total de energia durante o processo produtivo. Para estimar a emissão de GEE, foram aplicados princípios da metodologia de avaliação do ciclo de vida e recomendações do Painel Intergovernamental sobre Mudanças Climáticas (IPCC). Para cada 1,0 MJ de energia consumida na produção orgânica de arroz sob os sistemas orgânico e convencional, se produziram respectivamente em média, 10,5 MJ e 7,90 MJ de energia renovável, na forma de grãos. Os principais gastos energéticos no arroz orgânico foram com sementes, combustível, tratores, máquinas e implementos agrícolas e para o arroz convencional foram sementes, combustível e fertilizantes. Para cada 1 kg de grãos dos sistemas orgânicos e convencional são emitidos respectivamente 0,21 e 0,32 kg de CO2eq durante seus ciclos de produção e entrega no armazém, sendo as sementes, combustíveis e fertilizantes as principais fontes de emissão de CO2eq à atmosfera.(AU)

Energy efficiency and emissions of CO2, CH4, and N2O in organic and conventional rice production / Eficiência energética e emissões de CO2, CH4 e N2O em arroz sob cultivo orgânico e convencional

Rice is the second-most produced cereal worldwide and actively contributes to greenhouse gas (GHG) emissions, particularly methane, especially under deepwater production. Assessments of energy efficiency (EE) and GHG emissions can indicate the sustainability level of agrosystems and support decisions related to the reduction of production costs and environmental pollution. This study aimed to assess both EE and GHG emissions in organic and conventional rice production in the Southern region of Brazil. For this study, eight rice fields were evaluated. Energy inputs and outputs were calculated by multiplying the production input amounts by their respective calorific values or energy coefficients at each stage of production. EE was determined using the ratio between the total energy output and the total energy consumed during the production process. GHG emissions were estimated using the principles of the lifecycle assessment methodology in addition to the Intergovernmental Panel on Climate Change (IPCC) recommendations. Each 1.0 MJ consumed during the production of organic and conventional rice produced renewable energy averages of 10.5 MJ and 7.90 MJ, respectively, as grains. The primary energy expenses for organic rice were represented by seeds, fuel, tractors, and agricultural machinery and implements, and those for conventional rice were seeds, fuel, and fertilizers. Each kilogram of organic and conventional rice produced accounted for the emission of 0.21 and 0.32 kg of CO2eq, respectively, during the production cycles and delivery to the warehouse, with seeds, fuel, and fertilizers being the main sources of CO2eq emissions to the atmosphere.

O arroz é o segundo cereal mais cultivado no mundo e contribui ativamente nas emissões de GEE, principalmente em áreas produzidas sob inundação, com destaque para a produção de gás metano. A eficiência energética (EE) e as emissões de gases de efeito estufa (GEE) podem indicar o nível de sustentabilidade dos agrossistemas e a tomada de decisões relativas à redução dos custos de produção e poluição do ambiente. O objetivo deste trabalho foi avaliar a EE e emissões de GEE nas culturas do arroz sob cultivo orgânico e convencional na região sul do Brasil. Para isso, foram avaliadas oito áreas de arroz. As entradas e saídas de energia foram calculadas pela multiplicação da quantidade de produtos utilizados para a produção de arroz pelos seus respectivos poderes caloríficos ou coeficientes energéticos em cada etapa de produção. A EE foi obtida pela razão entre a quantidade de energia total de saída e o consumo total de energia durante o processo produtivo. Para estimar a emissão de GEE, foram aplicados princípios da metodologia de avaliação do ciclo de vida e recomendações do Painel Intergovernamental sobre Mudanças Climáticas (IPCC). Para cada 1,0 MJ de energia consumida na produção orgânica de arroz sob os sistemas orgânico e convencional, se produziram respectivamente em média, 10,5 MJ e 7,90 MJ de energia renovável, na forma de grãos. Os principais gastos energéticos no arroz orgânico foram com sementes, combustível, tratores, máquinas e implementos agrícolas e para o arroz convencional foram sementes, combustível e fertilizantes. Para cada 1 kg de grãos dos sistemas orgânicos e convencional são emitidos respectivamente 0,21 e 0,32 kg de CO2eq durante seus ciclos de produção e entrega no armazém, sendo as sementes, combustíveis e fertilizantes as principais fontes de emissão de CO2eq à atmosfera.

Effects of Oral Diazepam or Inhalatory Nitrous OxideOxygen for Conscious Sedation During Third Molar Surgery: A Randomized Controled Trial, Split Mouth Design / Efectos del Diazepam Oral o la Inhalación de Óxido Nitroso-Oxígeno para la Sedación Consciente Durante la Cirugía del Tercer Molar: Un Ensayo Controlado Aleatorio, Diseño de Boca Dividida

ABSTRACT: Anxiety in dental surgery may lead to behavioral and physiological changes for the patient and constitute a frequent challenge for the oral surgeon. The objective of this study was to compare the effect of inhalatory nitrous oxide and oxygen (N2O/O2) with oral diazepam conscious sedation in vital signs of patients undergone third molar extraction. Outpatients who needed removal of partially impacted, bilateral lower third molars, during the period of one year, were included. Each patient underwent conscious sedation with either oral diazepam or inhalatory N2O/O2 on a randomized controlled trial, split-mouth design. Systolic and diastolic blood pressure, heart rate and oxygen blood saturation were the changes measured before, at the beginning and the end of the procedure. Also, surgical procedure duration was recorded. Data from vital signs were submitted to analysis of variance and the duration of the surgery to paired Student's t-test. Twenty-five healthy outpatients (13 women and 12 men) with a mean age of 21.6 years were studied. There was an increase in systolic and diastolic pressure and in heart rate in the beginning; these values decreased and stabilized at the end of the surgical procedure in both treatments (p < 0.001) being lower in N2O/O2 but without difference between treatments. The surgical procedure duration was lower and occurred an expected increase of oximetry under N2O/O2 sedation (p < 0.001). Both treatments were effective for the conscious sedation but N2O/O2 showed better outcomes, mainly in duration of the surgery.

RESUMEN: La ansiedad en la cirugía dentoalveolar puede conducir a alteraciones fisiológicas y de comportamiento en el paciente, constituyendo así un desafío frecuente para el cirujano maxilofacial. El objetivo de este estudio fue comparar el efecto del óxido nitroso inhalatorio con oxígeno (N2O/O2) y la sedación consciente oral con diazepam por médio de los signos vitales de pacientes sometidos a la extracción del tercer molar. Fueron incluídos pacientes ambulatoriales com necesidad de exodoncia de terceros molares inferiores bilaterales, parcialmente impactados, durante el período de un año. Cada paciente fue sometido a sedación consciente con diazepam oral o N2O/O2 por inhalación en un ensayo controlado aleatorio, diseño de boca dividida. La presión arterial sistólica y diastólica, la frecuencia cardíaca y la saturación de oxígeno en la sangre fueron medidos antes, al inicio y al final del procedimiento. Además, se registró la duración del procedimiento quirúrgico. Los datos de los signos vitales fueron enviados para análisis de varianza y la duración de la cirugía para la prueba t de Student pareada. Se estudiaron 25 pacientes ambulatorios sanos (13 mujeres y 12 hombres) con una edad media de 21,6 años. Al início hubo un aumento en la presión sistólica y diastólica y en la frecuencia cardíaca; estos valores disminuyeron y se estabilizaron al final del procedimiento quirúrgico en ambos tratamientos (p <0,001), siendo más bajos en N2O/ O2 pero sin diferencia entre los tratamientos. La duración del procedimiento quirúrgico fue menor y se produjo un aumento esperado de la oximetría bajo sedación con N2O/O2 (p <0,001). Ambos tratamientos fueron efectivos para la sedación consciente, pero el N2O/O2 mostró mejores resultados, principalmente en la duración de la cirugía.

A 50-50% mixture of nitrous oxide-oxygen in transrectal ultrasound-guided prostate biopsy: A randomized and prospective clinical trial.

INTRODUCTION: Transrectal ultrasound-guided biopsy (TUSPB) is the standard method of diagnosis for prostate cancer, and although it is well tolerated by some patients, it presents a discomfort rate of 65 to 90%, which may be associated with pain. For convenience, it is agreed that a method of analgesia and sedation is necessary. For this purpose, this study aimed to evaluate the impact of inhalation of a 50-50% N2O-O2 gas mixture on pain intensity in these patients. MATERIAL AND METHODS: Randomized, double-blinded clinical trial, conducted at Antônio Pedro University Hospital (Hospital Universitário Antônio Pedro), Niterói, RJ, Brazil, containing two groups of 42 patients: a control (C) group, which received 100% oxygen inhalation, and a nitrous oxide (NO) group, which received inhalation of the 50-50% N2O-O2 mixture, self-administered during TUSPB. The pain intensity and degree of satisfaction were evaluated through a visual analogue scale (VAS), as was the frequency of adverse events. RESULTS: Eighty-four patients were included in the study, with 42 in each group. The mean pain intensity was lower in the NO group than in the C group [2.52 (0-10) vs 5.95 (0-10), p < 0.001], and the degree of satisfaction was higher in the NO group than in the C group (8.14 vs. 4.69, p < 0.001). The adverse effects were somnolence, dizziness, nausea, vomiting, discomfort and euphoria without differences between the groups. CONCLUSION: The 50-50% N2O-O2 mixture was effective in reducing pain intensity and increasing the degree of satisfaction in TUSPB, with tolerable side effects.

Comparison of DNA Damage and Oxidative Stress in Patients Anesthetized With Desflurane Associated or Not With Nitrous Oxide: A Prospective Randomized Clinical Trial.

BACKGROUND: Little is known about the effects of desflurane associated or not with nitrous oxide (N2O) on oxidative stress and patient genetic material. The aim of this study was to compare the effects of anesthesia maintained with desflurane associated or not with N2O on DNA damage (as a primary outcome) and oxidative stress (as a secondary outcome) in patients who underwent an elective minimally invasive surgery. METHODS: This prospective randomized clinical trial analyzed 40 patients of both sexes with an American Society of Anesthesiologists physical status I who were 18-50 years of age and scheduled for septoplasty. The patients were randomly allocated into 2 groups according to anesthesia maintenance as follows: desflurane (n = 20) or desflurane/N2O (n = 20). Blood samples were collected before anesthesia (T1 = baseline), 1.5 hours after anesthesia induction (T2), and on the morning of the postoperative first day (T3). Basal and oxidative DNA damage (determined using formamidopyrimidine DNA glycosylase to detect oxidized purines and endonuclease III to detect oxidized pyrimidines) were evaluated using the comet assay. Oxidative stress markers were evaluated based on lipid peroxidation (by assessing 4-hydroxynonenal and 8-iso-prostaglandin F2α [8-isoprostane] using enzyme linked immunosorbent immunoassay), protein carbonyls (assessed by enzyme linked immunosorbent immunoassay), and antioxidant defense (ferric-reducing antioxidant power by spectrophotometry). The effect size was expressed as the mean differences between groups and the corresponding 95% confidence interval (CI). RESULTS: There was no significant mean difference between groups in relation to DNA damage (-1.7 [95% CI, -7.0 to 3.5]), oxidized DNA pyrimidines (-1.8 [95% CI, -12.5 to 8.9]) and purines (-1.9 [95% CI, -13.9 to 10.1]), 4-hydroxynonenal (-0.2 [95% CI, -2.8 to 2.4]), 8-isoprostane (549 [95% CI, -2378 to 3476]), protein carbonyls (0.2 [95% CI, -2.1 to 2.3]), or ferric-reducing antioxidant power (24 [95% CI, -52.0 to 117.2]). CONCLUSIONS: The coadministration of 60% N2O with desflurane did not seem to impair the effects on DNA or the redox status compared with desflurane anesthesia, suggesting that both studied anesthetic techniques can be suitable options for healthy individuals who undergo minimally invasive surgery lasting at least 1.5 hours. However, due to the low power of the study, more research is necessary to confirm our findings.

Effects of nitrous oxide on cardiovascular parameters in pigs anesthetized with propofol and subjected to pressure-controlled ventilation / Efeitos do óxido nitroso sobre parâmetros cardiovasculares em suínos anestesiados com propofol e mantidos em ventilação controlada à pressão

This paper evaluated the effects of the ratio of nitrous oxide to oxygen (50% of each) on cardiovascular parameters in pigs anesthetized with propofol and maintained in ventilation with intermittent positive pressure. Sixteen Large White pigs, weighing between 15 and 20 kg, were divided into two groups of eight animals, and designated as follows: GPN (propofol/nitrous oxide) and GPA (propofol/compressed air). In order to allow endotracheal intubation, the animals received azaperone (2 mg kg-1, IM) followed, after 20 minutes, by intravenous propofol. After successful intubation, continuous infusion of propofol was initiated at a dose of 0.4 mg kg-1minute-1. From this point, the GPN group received N2O (diluted in 50% oxygen), while the GPA group received compressed air (diluted in 50% oxygen). Rocuronium was then administered by continuous intravenous infusion at 0.6 mg kg-1h-1. Pressure-controlled ventilation (PCV) was started and adjusted to 15 cmH2O, and the respiratory rate was set to reach capnometry readings between 35-45 mmHg. The measurement of parameters (heart rate, mean arterial pressure, cardiac index, systemic vascular resistance index, stroke index) begun 15 minutes after the administration of rocuronium, and was repeated in 15-minute intervals for 60 minutes. Data were statistically analyzed by ANOVA followed by Bonferroni test. The results showed that the 1:1 ratio combination of nitrous oxide to oxygen (50% each) did not alter the mentioned parameters in pigsanesthetized with propofol and maintained at pressure-controlled ventilation, indicating that it is a safeprotocol for the cardiovascular system.(AU)

Objetivou-se com este trabalho avaliar os efeitos da associação de óxido nitroso (N2O) ao oxigênio, na proporção de 50% cada, sobre os parâmetros cardiovasculares em suínos anestesiados com propofol e mantidos em ventilação com pressão positiva intermitente. Para isso, foram utilizados 16 suínos da raça Large White com pesos entre 15 e 20 kg, distribuídos em dois grupos de oito animais cada, assim nomeados: GPN (GrupoPropofol/Óxidonitroso) e GPA (GrupoPropofol/Arcomprimido). Os animais receberam azaperona (2mgkg-1,IM) e após 20 minutos, administrou-se propofol por via intravenosa, em doses suficientes para permitir a intubação traqueal. Após intubação, iniciou-se a infusão contínua de propofol na dose de 0,4mgkg-1minuto-1. A partir deste momento, os animais do GPN receberam N2O diluído em 50% de oxigênio e os do GPA, ar comprimido diluído em 50% de oxigênio. Ato contínuo, administrou-se, por infusão intravenosa contínua, rocurônio a 0,6mgkg-1h-1. A ventilação controlada a pressão (VCP) foi iniciada e ajustada a 15cmH2O e a freqüência respiratória foi regulada para alcançar valores de capnometria entre 35-45mmHg. A medição dos parâmetros (freqüência cardíaca, pressão arterial média, índice cardíaco, índice da resistência periférica total, índice sistólico) iniciou-se após 15 minutos da administração de rocurônio, repetindo-se a cada 15 minutos, durante um intervalo de 60 minutos. Os dados foram submetidos à análise estatística pela ANOVA seguida pelo teste de Bonferroni.Os resultados mostraram que a associação do óxido nitroso ao oxigênio na proporção de 50% cada emsuíno anestesiado com propofol e mantido em ventilação controlada à pressão não provoca alteraçõescardiovasculares clinicamente relevantes.(AU)

Effects of nitrous oxide on cardiovascular parameters in pigs anesthetized with propofol and subjected to pressure-controlled ventilation / Efeitos do óxido nitroso sobre parâmetros cardiovasculares em suínos anestesiados com propofol e mantidos em ventilação controlada à pressão

This paper evaluated the effects of the ratio of nitrous oxide to oxygen (50% of each) on cardiovascular parameters in pigs anesthetized with propofol and maintained in ventilation with intermittent positive pressure. Sixteen Large White pigs, weighing between 15 and 20 kg, were divided into two groups of eight animals, and designated as follows: GPN (propofol/nitrous oxide) and GPA (propofol/compressed air). In order to allow endotracheal intubation, the animals received azaperone (2 mg kg-1, IM) followed, after 20 minutes, by intravenous propofol. After successful intubation, continuous infusion of propofol was initiated at a dose of 0.4 mg kg-1minute-1. From this point, the GPN group received N2O (diluted in 50% oxygen), while the GPA group received compressed air (diluted in 50% oxygen). Rocuronium was then administered by continuous intravenous infusion at 0.6 mg kg-1h-1. Pressure-controlled ventilation (PCV) was started and adjusted to 15 cmH2O, and the respiratory rate was set to reach capnometry readings between 35-45 mmHg. The measurement of parameters (heart rate, mean arterial pressure, cardiac index, systemic vascular resistance index, stroke index) begun 15 minutes after the administration of rocuronium, and was repeated in 15-minute intervals for 60 minutes. Data were statistically analyzed by ANOVA followed by Bonferroni test. The results showed that the 1:1 ratio combination of nitrous oxide to oxygen (50% each) did not alter the mentioned parameters in pigsanesthetized with propofol and maintained at pressure-controlled ventilation, indicating that it is a safeprotocol for the cardiovascular system.

Objetivou-se com este trabalho avaliar os efeitos da associação de óxido nitroso (N2O) ao oxigênio, na proporção de 50% cada, sobre os parâmetros cardiovasculares em suínos anestesiados com propofol e mantidos em ventilação com pressão positiva intermitente. Para isso, foram utilizados 16 suínos da raça Large White com pesos entre 15 e 20 kg, distribuídos em dois grupos de oito animais cada, assim nomeados: GPN (GrupoPropofol/Óxidonitroso) e GPA (GrupoPropofol/Arcomprimido). Os animais receberam azaperona (2mgkg-1,IM) e após 20 minutos, administrou-se propofol por via intravenosa, em doses suficientes para permitir a intubação traqueal. Após intubação, iniciou-se a infusão contínua de propofol na dose de 0,4mgkg-1minuto-1. A partir deste momento, os animais do GPN receberam N2O diluído em 50% de oxigênio e os do GPA, ar comprimido diluído em 50% de oxigênio. Ato contínuo, administrou-se, por infusão intravenosa contínua, rocurônio a 0,6mgkg-1h-1. A ventilação controlada a pressão (VCP) foi iniciada e ajustada a 15cmH2O e a freqüência respiratória foi regulada para alcançar valores de capnometria entre 35-45mmHg. A medição dos parâmetros (freqüência cardíaca, pressão arterial média, índice cardíaco, índice da resistência periférica total, índice sistólico) iniciou-se após 15 minutos da administração de rocurônio, repetindo-se a cada 15 minutos, durante um intervalo de 60 minutos. Os dados foram submetidos à análise estatística pela ANOVA seguida pelo teste de Bonferroni.Os resultados mostraram que a associação do óxido nitroso ao oxigênio na proporção de 50% cada emsuíno anestesiado com propofol e mantido em ventilação controlada à pressão não provoca alteraçõescardiovasculares clinicamente relevantes.

Practice Patterns and Adverse Events of Nitrous Oxide Sedation and Analgesia: A Report from the Pediatric Sedation Research Consortium.

OBJECTIVES: To describe practice patterns and adverse events associated with nitrous oxide (N2O) administration as the primary sedative outside the operating room in varied settings by a diverse range of providers, and to identify patient and sedation characteristics associated with adverse events. STUDY DESIGN: Data prospectively collected by the Pediatric Sedation Research Consortium, which is comprised of 40 children's and general/community hospitals, was retrospectively analyzed for children who received N2O as the primary sedative. Descriptive measures of patient and sedation characteristics and adverse events were reported. A multivariable regression model was used to assess potential associations between patient and sedation characteristics and adverse events. RESULTS: A total of 1634 N2O administrations were identified. The majority was performed in sedation units, and most by advanced practice nurses or physician assistants. The most common adjunct medication was midazolam. There was a low prevalence of adverse events (6.5%), with vomiting as the most common (2.4%) and only 3 (0.2%) serious adverse events reported. The odds of vomiting increased when concomitant opioids were administered (OR 2.89, 95% CI 1.14, 7.32) and when nil per os (NPO) clear fluids <2 hours (OR 4.16, 95% CI 1.61, 10.76). NPO full meal <6 hours did not change the odds of vomiting (OR 1.42, 95% CI 0.57, 3.57). There were no aspiration events. CONCLUSIONS: There was a very low prevalence of serious adverse events during N2O administration in children outside of the operating room and by nonanesthesiologists. The odds of vomiting increased when concomitant opioids were administered and NPO clear fluids <2 hours.

Does occupational exposure to anesthetic gases lead to increase of pro-inflammatory cytokines?

INTRODUCTION: There is great concern about the possible harmful effects of exposure to volatile anesthetics. The current study aimed at evaluating, for the first time, the effects of occupational exposure to anesthetic gases on physicians who work in operating rooms, by determining several inflammatory cytokines. MATERIALS AND METHODS: Plasma inflammatory cytokines (IL-1ß, -6, -8, -10, -12, TNF-α) were investigated in 30 individuals who were allocated into two groups of 15: the exposed group, consisting of operating room medical personnel exposed to a mixture of anesthetic gases for 3 years, and a control group composed of medical personnel not exposed to anesthetic gases. The concentrations of volatile anesthetics were measured in the operating room by means of an infrared portable analyzer RESULTS AND CONCLUSIONS: Our findings suggest an increase of the pro-inflammatory IL-8 (p<0.05) in medical personnel exposed to high concentrations of anesthetic gases, even for a relatively short period.

[Use of nitrous oxide in Uruguay]. / Utilización de oxido nitroso en Uruguay.

BACKGROUND: Nitrous oxide (N2O) is a medicinal gas that has been used for anesthesia for over a century and a half. As evidence of the adverse effects of N2O have been contrasted with the good safety profiles of new anesthetic agents, use of the older gas has declined. OBJECTIVE: To describe and analyze the use of N2O for anesthesia in the Eastern Republic of Uruguay. To describe the use of other drugs for general anesthesia. METHODS: The study had 2 phases. In the first phase, information on the use of N2O and other drugs for general anesthesia was obtained from the medical records of a sample of patients who underwent surgery between November 2007 and November 2008 at nationally important hospitals. In the second phase 80 physician anesthesiologists were surveyed to obtain information on their reported use of N2O for general anesthesia. The respondents were found working during the first half of 2008. RESULTS: A total of 104 patients' records were read and 80 anesthesiologists were surveyed. We found that 31 (29.8%) patients received N2O during anesthesia. The survey showed that 62 (77.5%) of the anesthesiologists had used N2O in the last 6 months. Nine (50%) of the anesthesiologists who had not used N2O said their reason was that it was unavailable. The other 9 referred either to the risk of postoperative nausea and/or vomiting (n = 6) or the fact of having better alternatives (n = 9). CONCLUSION: This study shows that N2O is little used in current anesthesia practice. The tendency in Uruguay continues to be toward declining use.