Mehtap Ozdemir, Nurten Bakan, Murat Haliloglu, Yonca Yanli, Nevin Kurt Celebi, Zeynel Abidin Erbesler, Tulin Yollu
Mehtap Ozdemir, Nurten Bakan, Murat Haliloglu, Yonca Yanli, Nevin Kurt Celebi, Zeynel Abidin Erbesler, Tulin Yollu, The Effects Of Nitrous Oxide On Postoperative Pain, Nausea Vomiting and Intraoperative Haemodynamics in Robotic Gynecologic Surgery(2017)SDRP Journal of Anesthesia & Surgery 2(2)
In recent years there has been an increase in gynaecological operations performed with robotic surgery. In these procedures, nitrous oxide(N2O) or air are used together with inhalation anaesthestics. In this study we aimed to compare the effects of O2/N2O or O2/Air on postoperative pain, nausea vomiting (PONV) and intraoperative haemodynamics in robotic surgery.
Aged 28-71 years, classified ASA I-II, 58 patients were separated into 2 groups. Following induction, anaesthesia was maintained O2/Air (Group A) or O2/N2O (Group N) with sevoflurane. Heart rate (HR), mean arterial pressure (MAP), Central Venous Pressure (CVP), end tidal carbon dioxide (ETCO2), peripheral oxygen saturation (SpO2), Aldrete recovery score (ARS), postoperative nausea and vomiting (PONV) and visual analog scale (VAS) were recorded during the operation and postoperative period.
The VAS values were higher in Group N at 5th min and higher in Group A at 150th min (p<0.05). In the intragroup analysis, VAS values were significantly lower at 120th, 150th, 180th min compared with 5th, 15th, 30th and 60th min in Group N (p<0.05). In Group A, the values at 15th, 30th min was significantly higher than 60th, 120th and 180th min (p<0.05). Intraoperative haemodynamic parameters (HR, MAP, CVP) were similar in two groups (p>0.05). Intragroup analysis of PONV values were significantly lower at 150th and 180th min compared with both 5th and 30th min in Group N and significantly higher at 5th min compared with 180th min in Group A (p<0.05).
With regard to acute postoperative analgesia we could not find any significant difference between N2O and air. Further clinical studies are required to investigate this subject in respect of differences (at 5th min and at 150th min) in the VAS scores.
Keywords: Robotic surgery, Nitrous oxit, General anesthesia, Visual analog scale, Postoperative nausea vomiting
Goswami S, Nishanian E, Mets B. Anesthesia for robotic surgery . In Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young WL ed. Miller's Anesthesia. 7th ed. Philadelphia, PA:Elsevier; 2010:1103, p.2389-2395.
Hsu RL, Kaye AD, Urman RD: Anesthetic Challenges in Robotic-Assisted Urologic Surgery. Rev Urol. 2013; 15(4):178-184. PMid:24659914 PMCid:PMC3922322
Lee JR. Anesthetic considerations for robotic surgery. Korean J Anesthesiol 2014; 66(1):3-11. PMid:24567806 PMCid:PMC3926998View Article PubMed/NCBI
Suh MK, Seong KW, Jung SH, Kim SS. The effect of pneumoperitoneum and Trendelenburg position on respiratory mechanics during pelviscopic surgery. Korean J Anesthesiol. 2010;59:329-34. PMid:21179295 PMCid:PMC2998653View Article PubMed/NCBI
Hirvonen EA, Nuutinen LS, Kauko M. Hemodynamic changes due to Trendelenburg positioning and pneumoperitoneum during laparascopic hysterectomy. Acta Anaesthesiol Scand. 1995;39:949-955. PMid:8848897View Article PubMed/NCBI
Pandey P, Garg R, Roy K, Darlong V, Punj J, Kumar A. Perianesthetic management of the first robotic partial cystectomy in bladder pheochromocytoma. A case report. Minerva Anestesiol 2010;76:294-7. PMid:20332744
Darlong V, Kunhabdulla NP, Pandey R, Chandralekha, Punj J, Garg R et al. Hemodynamic changes during robotic radical prostatectomy. Saudi J Anaesth 2012;6(3):213-8. PMid:23162392 PMCid:PMC3498657View Article PubMed/NCBI
Richebe P, Rivat C, Creton C, Laulin JP, Maurette P, Lemaire M et al. Nitrous oxide revisited. Anesthesiology 2005; 103:845-54. PMid:16192778View Article PubMed/NCBI
Stiglitz DK, Amaratunge LN, Konstantatos AH, Lindholm DE. Intraoperative nitrous oxide as a preventive analgesic. Anaesth Intensive Care 2010; 38:890-3. PMid:20865874
Morgan GE, Mikhail MS, Murray MJ. Inhalational Anesthetics. In: Larson CP ed. Clinical Anesthesiology. 3rd ed. New York: Mc Grraw Hill, 2002.p.137-9.
Aldrete JA, Kroulik D. A postanesthetic recovery score. Anesth Analg 1970; 49: 924 ? 34. PMid:5534693View Article PubMed/NCBI
Fujinaga M, Maze M. Neurobiology of Nitrous Oxide-Induced Antinociceptive Effects. Mol Neurobiol 2002;25(2):167-89.View Article
Sawamura S, Obara M, Takeda K, Maze M, Hanaoka K. Corticotropin-releasing factor mediates the antinociceptive action of nitrous oxide in rats. Anesthesiology 2003; 99:708-15. PMid:12960557View Article PubMed/NCBI
Santos M, Kuncar V, Martinez-Taboada F, Tendillo FJ. Large concentrations of nitrous oxide decrease the isoflurane minimum alveolar concentration sparing effect of morphine in the rat. Anesth Analg 2005; 100:404-8. PMid:15673866View Article PubMed/NCBI
Echevarria G, Elgueta F, Fierro C et al. Nitrous oxide (N2O) reduces postoperative opioid-induced hyperalgesia after remifentanil-propofol anesthesia in humans. Br J Anaesth 2011; 107:959-65. PMid:21965050View Article PubMed/NCBI
Chan MT, Wan AC, Gin T, Leslie K, Myles PS.Chronic postsurgical pain after nitrous oxide anaesthesia. Pain 2011; 152:2514-20. PMid:21889262View Article PubMed/NCBI
Arellano RJ, Pole ML, Rafuse SE, Fletcher M, Saad YG, Friedlander M et al. Omission of nitrous oxide from a propofol-based anesthetic does not affect the recovery of women undergoing outpatient gynecologic surgery. Anesthesiology 2000; 93:332-9. PMid:10910478View Article PubMed/NCBI
Kawamura R, Stanley TH, English JB, Hill GE, Liu WS, Webster LR. Cardiovascular responses to nitrous oxide exposure for two hours man. Anesth Analg 1980; 59:93-9. PMid:7189344View Article PubMed/NCBI
Eisele JH, Smith NT. Cardiovascular effects of 40 percent nitrous oxide in man. Anesth Analg 1972; 51:956-63. PMid:4673937View Article PubMed/NCBI
Lichtenthal P, Philip J, Sloss LJ, Gabel R, Lesch M. Administration of nitrous oxide in normal subjects. Evaluation of systems of gas delivery for their clinical use and hemodynamic effects. Chest 1977; 72:316-22. PMid:891283View Article PubMed/NCBI
Henry RJ, Quock RM. Cardiovascular influences of nitrous oxide in spontaneously hypertensive rats. Anesth Prog 1989;36(3):88-92. PMid:2638155 PMCid:PMC2148656
Turan A, Mascha EJ, You J, Kurz A, Shiba A, Saager L et al. The association between nitrous oxide and postoperative mortality and morbidity after noncardiac surgery. Anesth Analg 2013; 116(5):1026-33. PMid:22822187View Article PubMed/NCBI
Myles PS, Leslie K, Chan MT, Forbes A, Paech MJ, Peyton P et al. Avoidance of nitrous oxide for patients undergoing major surgery: a randomized controlled trial. Anesthesiology 2007; 107.221-31.
Apfel CC, Laara E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology 1999; 91:693-700. PMid:10485781View Article PubMed/NCBI
Macario A, Weinger M, Carney S, Kim A. Which clinical anesthesia outcomes important to avoid? The perspective of patients. Anesth Analg 1999; 89:652-8.View Article
Ruphert J, Dworacek B, Bonke B, Dzoljic MR, van Eijndhoven JH, de Vlieger M. Tolerance to nitrous oxide in volunteers. Acta Anaesthesiol Scand 1985; 29:635-8.View Article
Mraovic B, Simurina T, Sonicki Z, Skitarelic N, Gan TJ. The dose-response of nitrous oxide in postoperative nausea in patients undergoing gynecologic laparascopic surgery: A preliminary study. Anesth Analg. 2008; 107(3):818-23. PMid:18713890View Article PubMed/NCBI
Leslie K, Myles PS, Chan MTV, Paech MJ, Peyton P, Forbes A et al. Risk factors for severe postoperative nausea and vomiting in a randomized trial of nitrous oxide-based vs nitrous oxide-free anaesthesia. Br J Anaesth 2008; 101(4):498-505. PMid:18682411View Article PubMed/NCBI
Muir JJ, Warner MA, Offord KP, Buck CF, Harper JV, Kunkel SE. Role of nitrous oxide and other risk factors in postoperative nausea and vomiting: A randomized and blinded prospective study. Anesthesiology 1987; 66:513-8. PMid:3565818View Article PubMed/NCBI
Sukhani R, Lurie J, Jabamoni R: Propofol for ambulatory gynecologic laparascopy: Does omission of nitrous oxide alter postoperative emetic sequelae and recovery? Anest Analg 1994; 78:831-5. PMid:8160978
Park SK, Cho EJ. A randomized controlled trial of two different interventions fort he prevention of postoperative nausea and vomiting :total intravenous anaesthesia using propofol and remifentanil versus prophylactic palonosetron with inhalational anaesthessia using sevoflurane-nitrous oxide. J Int Med Res 2011; 39:1808-15. PMid:22117981View Article PubMed/NCBI
Divatia JV, Vaidya JS, Badwe RA, Hawaldar RW. Omission of nitrous oxide during anesthesia reduces the incidens of postoperative nausea and vomiting. A meta-analysis. Anesthesiology 1996;85:1055-62. PMid:8916823View Article PubMed/NCBI
Apfel CC, Kranke P, Katz MH, Goepfert C, Papenfuss T, Rauch S et al. Volatile anesthetics may be the main cause of early but not delayed postoperative vomiting: a randomized controlled trial of factorial design. Br J Anaesth 2002; 88:659-68. PMid:12067003View Article PubMed/NCBI
Schallner N, Goebel U. The perioperative use of nitrous oxide: renaissance of an old gas or funeral of an ancient relict. Curr Opin Anesthesiol 2013; 26:354-60. PMid:23426038View Article PubMed/NCBI