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Original article 99
Keywords:
induction dose, nitrous oxide, propofol
Both the groups were kept nil per os, 8 h for solids
and 2 h for clear fluids. All patients received ranitidine
150 mg, metoclopramide 10 mg, and alprazolam 0.5 Results
mg orally on the night before surgery. Ranitidine 150 Distribution of age, sex, height, weight, and
mg and metoclopramide 10 mg were repeated with ASA grading of the patients in both groups were
a sip of water on the day of surgery. In the theater, a comparable.
large bore intravenous access was started under local
anesthesia and patients were premedicated with The mean dose of propofol required for induction was
intravenous glycopyrrolate 0.2 mg and intravenous significantly lower in group A compared with group
fetanyl 2 g/kg. B (30.4 ± 26.17 vs. 101.87 ± 26.19, Table 1, Fig. 1).
Similarly, the induction time was also significantly
Patients in group A were asked to inhale 4 l/min nitrous shorter in group A (1.52 ± 1.31 vs. 5.09 ± 1.33,
oxide and 2 l/min of oxygen, whereas patients in group Table 2, Fig. 2).
B were preoxygenated with 6 l/min of oxygen for
3 min with a tight-fitting face mask. Loss of response Heart rate in both groups at preinduction as well
to verbal command (taking deep breaths/opening eyes) as throughout the study period were comparable
and no response to jaw thrust were considered the
endpoint of induction. Figure 1
Nitrous oxide inhalation reduces induction dose of propofol Rajan et al. 101
(P < 0.05, Table 3, Fig. 3). Preinduction MAP was Preinduction oxygen saturation was comparable
comparable between groups, but at induction, group between groups. Statistically, there was a significant
A had a significantly higher MAP (94.51 ± 16.21 difference at induction, with group B showing a
vs. 86.57 ± 15.47, P = 0.002). However, MAP higher value (99.81 ± 0.46 vs. 99.96 ± 0.26, P = 0.887).
values were significantly higher in group B at 5 min Thereafter, it was comparable in both groups (Table 5,
(83.09 ± 12.935 vs. 88.42 ± 14.600, P = 0.019) and 10 Fig. 5). No patient developed desaturation (SpO2<90%)
min (82.12 ± 12.013 vs. 87.21 ± 13.225, P = 0.014), during the study.a
Table 4, Fig. 4).
Table 4 Comparison of the mean arterial pressure
Figure 3
Figure 2
Figure 4 Figure 5
Table 5 Comparison of oxygen saturation not very effective in preventing this hypotension,
Time Group A Group B P value whereas combining propofol with ketamine [15,16] or
(mean ± SD) (mean ± SD)
etomidate [16] may prevent hypotension. Conflicting
Preinduction 99.87 ± 0.475 99.92 ± 0.270 0.887 results have been found on the effectiveness of
Loss of 99.81 ± 0.460 99.96 ± 0.257 0.004
response (min)
ephedrine in this respect [13–15,17–19]. However, this
1 99.79 ± 0.890 99.82 ± 0.421 0.135 drawback of propofol induction could be overcome to
3 99.85 ± 0.485 99.49 ± 0.455 0.146 a huge extent by 3 min of nitrous oxide inhalation, as
5 99.891 ± 0.452 99.83 ± 0.571 0.298 observed in our study, as hypotension at loss of verbal
10 99.89 ± 0.388 99.94 ± 0.296 0.482 response was comparatively less.
15 99.85 ± 0.425 99.90 ± 0.347 0.549
Whether a reduction in the induction dose of
propofol could lead to an exaggerated stress response
Discussion to laryngoscopy and intubation would be a natural
The essential components of anesthesia include concern. It was found that nitrous oxide inhalation
immobility, unconsciousness, and suppression of effectively suppressed the heart rate as well as the
autonomic responses. This can be achieved with the hypertensive responses, at the same time maintaining
judicious use of multiple drugs, which include inhaled MAP at induction.
and intravenous agents. Use of a single drug to provide
Another concern while adopting this technique could
adequate depth of anesthesia could be dangerous
be desaturation. No desaturation was observed at
as higher doses may be required with an increased
induction and saturations in both groups remained
risk of side effects. Thus, combinations of drugs
well within clinically acceptable limits (99.81 ± 0.46
that potentiate the anesthetic effects will enable the
vs. 99.96 ± 0.26). Thus, if patients are chosen carefully,
usage of fewer drugs, which will subsequently reduce
avoiding those with anticipated difficult airway and
complications. It has been documented that when used
low cardiorespiratory reserve, the technique seems to
in conjunction, nitrous oxide decreases the requirement
be quite safe in experienced hands.
of intravenous anesthetic agents such as thiopentone
and propofol [2–4].
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and without nitrous oxide 67%. Br J Anaesth 2000; 84:638–639.
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Nitrous oxide inhalation reduces induction dose of propofol Rajan et al. 103
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