Omission of Nitrous Oxide during Anesthesia Reduces the Incidence of Postoperative Nausea and Vomiting: A Meta-Analysis

@article{Divatia1996OmissionON,
  title={Omission of Nitrous Oxide during Anesthesia Reduces the Incidence of Postoperative Nausea and Vomiting: A Meta-Analysis},
  author={Jigeeshu Vasishtha Divatia and Jayant S. Vaidya and Rajendra A Badwe and Rohini W Hawaldar},
  journal={Anesthesiology},
  year={1996},
  volume={85},
  pages={1055-1062}
}
Background Postoperative nausea and vomiting are important causes of morbidity after general anesthesia. Nitrous oxide has been implicated as an emetogenic agent in many studies. However, several other trials have failed to sustain this claim. The authors tried to resolve this issue through a meta-analysis of randomized controlled trials comparing the incidence of postoperative nausea and vomiting after anesthesia with or without nitrous oxide. Methods Of 37 published studies retrieved by a… 
Association between nitrous oxide and the incidence of postoperative nausea and vomiting in adults: a systematic review and meta‐analysis
TLDR
It is concluded that avoiding nitrous oxide does reduce the risk of postoperative nausea and vomiting, especially in women, but the overall impact is modest.
Nitrous Oxide–related Postoperative Nausea and Vomiting Depends on Duration of Exposure
TLDR
No clinically significant effect of nitrous oxide on the risk of PONV exists under an hour of exposure, and this duration-related effect may be via disturbance of methionine and folate metabolism.
THE EFFECT OF NITROUS OXIDE ON POSTOPERATIVE NAUSEA AND VOMITING
TLDR
It is demonstrated that nitrous oxide does not increase the incidence or severity of PONV in patients undergoing laparoscopic cholecystectomy and the percentage of patients needing antiemetics between groups.
The Effect of 50 % Nitrous Oxide on Postoperative Nausea-Vomiting in Patients Undergoing Laparoscopic Cholecystectomy
TLDR
It is concluded that 50% nitrous oxide does not increase the incidence or severity of PONV in patients undergoing laparoscopic cholecystectomy and the percentage of patients needing antiemetics between two groups.
The Dose–Response of Nitrous Oxide in Postoperative Nausea in Patients Undergoing Gynecologic Laparoscopic Surgery: A Preliminary Study
TLDR
N2O increases the incidence of postoperative nausea after gynecologic laparoscopic surgery, and a preliminary finding indicates that N2O may increase PONV in a dose-dependent fashion.
Effects of nitrous oxide on intraoperative bowel distension
TLDR
It is determined in a metaanalysis that the chance of having intraoperative bowel distension was increased about two fold in patients receiving nitrous oxide as the anaesthetic carrier gas compared with those receiving nitrogen or oxygen.
Volatile anaesthetics may be the main cause of early but not delayed postoperative vomiting: a randomized controlled trial of factorial design.
TLDR
In patients at high risk for PONV, it would therefore make better sense to avoid inhalational anaesthesia rather than simply to add an antiemetic, which may still be needed to prevent or treat delayed vomiting.
Randomized Controlled Trial of Total Intravenous Anesthesia with Propofol versus Inhalation Anesthesia with Isoflurane–Nitrous Oxide: Postoperative Nausea and Vomiting and Economic Analysis
TLDR
Propofol TIVA results in a clinically relevant reduction of postoperative nausea and vomiting compared with isoflurane–nitrous oxide anesthesia (number needed to treat = 6).
Risk Assessment of Postoperative Nausea and Vomiting
TLDR
This review provides an update on risk factors for PONV and explains how risk models—based on “true” risk factors—could be developed and the applicability but also the limitations of predictive models will be discussed.
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TLDR
Clinically important risk of major harm reduces the usefulness of omitting N2O to prevent postoperative emesis, and the combined NNT to prevent both early and late vomiting with a N1O-free anaesthetic is about 13.
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TLDR
It is unable to demonstrate that N2O induces vomiting by children after a brief general anaesthetic for myringotomy, as well as whether nitrous oxide has a clinically important effect on postoperative vomiting in children after myringectomy.
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TLDR
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A total of 110 patients undergoing elective abdominal hysterectomy were anesthetized in random order with either isoflurane in nitrous oxide and oxygen or isoflurane in air and oxygen. Fentanyl was
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TLDR
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TLDR
It follows that N2 O increases the incidence of emesis compared to alternative anesthetics, such that an increased incidence of vomiting should occur in about half of the studies examined.
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TLDR
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TLDR
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TLDR
It is concluded that nitrous oxide has no influence on recovery after laparoscopic cholecystectomy and return to work and normal daily activities was the same in the two groups.
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