Noninvasive assessment of diffusion hypoxia following administration of nitrous oxide-oxygen.

The phenomenon of diffusion hypoxia is commonly believed to occur unless nitrous oxide-oxygen inhalation sedation is followed by "washout" with 100% oxygen for 5 minutes upon termination of the flow of nitrous oxide. When systematically studied, however, this phenomenon generally appears to be unfounded. The present study evaluated the effect of breathing room air instead of 100% oxygen in healthy (ASA 1) human volunteers following administration of sedative concentrations of nitrous oxide. The occurrence of hypoxia was determined objectively, using pulse oximetry and a standardized psychomotor skills test (Trieger test). Diffusion hypoxia was not observed using these criteria.

REDUCAO DA CONCENTRACAO ALVEOLAR MINIMA DO ISOFLURANO E DO SEVOFLURANO PELO SUFENTANIL

Background and Objectives - Inhalational anesthetics have a mild analgesic effect. The reduction of alveolar concentration (MAC) of potent volatile anesthesics by increasing plasma concentrations of opioids is desired in inhalational anesthesia. The purpose of this study was to determine the role of sufentanil in reducing sevoflurane and isoflurane MAC. Methods - Thirty eight adult patients of both genders, physical status ASA I or II, submitted to major abdominal procedures were randomly allocated into two groups. Group I (n = 24) received inahalational anesthesia with sevoflurane and Group II (n = 14) received inhalational anesthesia with isoflurane, both diluted in a mixture of N2O (1 liter) and O2 (0.5 liter). A semi-closed system with CO2 absorber and partial reinhalation was used. Ventilation was mechanically controlled. Sufentanil infusion was administered aiming at obtaining 0.5 ng.ml-1 of plasma concentration. Sufentanil plasma concentration was previously calculated by a computer software. End-tidal concentrations were obtained through a gas analyzer and measured at 15 minutes (M1), 30 minutes (M2), 60 minutes (M3), 90 minutes (M4) and 120 minutes (M5). Systolic and diastolic blood pressure (SBP and DBP) and heart rate (RR) were measured during the same periods with the addition of M0 (pre-anesthetic period). Hourly consumption of the inhalational anesthetic agent (IAC), extubation time (ET = time between admission to the recovery room and extubation) and stay in the post anesthesia recovery room (PA-RR) were also measured. Results - Type and duration of surgeries were similar for both groups. There were no statistically significant differences in MAC, SBP, DBP, RR, IAC, TE and PA-RR between groups. Systolic blood pressure in group I (sevoflurane) showed differences among periods F = 3.82 p < O.05; (M2 = M3)(M4 = M5) and M1 had a intermediate value. MAC in group I showed differences among periods F = 9.0 p < 0.05; M1 < M3. MAC in group II also showed differences among periods F = 13.03 p < O.05; M1 < (M2,M3,M4,M5). Conclusions - Both groups had similar behavior when associated to sufentanil in major abdominal surgeries. Group II showed a higher cardiac and circulatory stability.

Comparacao da recuperacao de anestesia venosa com propofol e anestesia inalatoria com sevoflurano para laparoscopia ginecologica

Backgrounds and Objectives: Both continuous venous anesthesia with propofol and inhalational anesthesia with sevoflurane propitiate fast arousal with few side effects. The aim of this study was to compare the arousal and post anesthestic recovery times in patients submitted to these two agents. Methods: Forty three patient aged 18 to 50 years, physical status I or II, submitted to gynecological laparoscopy were distributed in two groups: G1 - propofol in continuous infusion of 115 μg.kg -1.min -1 and G2 sevoflurane. All the patients were pre-medicated with 7.5 mg midazolam, sufentanil 0.5 μg.kg -1, propofol 2 mg.kg -1, atracurium 0.5 mg.kg -1, N 2O in 50% of oxygen in a no-rebreathing system. The depth of the anesthesia and arousal time were assessed by the Bispectral index (BIS). The time between end of anesthesia and eye opening, time for command response and time for orientation were also evaluated. Results: The times recorded in minutes were: G1 - eye opening 8.2 ± 2.9, command response 8.6 ± 3.1, orientation 9.8 ± 3.4, recovery 31.6 ± 3.8; G2 - eye opening 4.5 ± 3, command response 4.9 ± 3.4, orientation 6.2 ± 3.4, recovery 66 ± 8. Except the recovery time, all the values were larger in G1. Conclusions: Both intravenous propofol or inhalational sevoflurane were considered excellent anesthetic techniques as to recovery time and recovery room discharge. Sevoflurane provided an earlier arousal with a longer recovery room stay as compared to propofol.

Effects of nitrous oxide on IOP and pupillary diameter in dogs anesthetized with varying concentrations of desflurane

Objective The aim of the present study was to evaluate the effects of nitrous oxide on TOP and pupillary diameter (PD) of dogs anesthetized with varying desflurane concentrations.Animals studied Twenty adult Mongrel dogs were used.Methods They were anesthetized with propofol (10 mg/kg, IV) and maintained with varying concentrations of desflurane (1.6, 1.4, and 1.2 MAC diluted in 100% oxygen (G1) or in 70% nitrous oxide and 30% oxygen (G2) (30 mL/kg/min). TOP was measured by applanation tonometry and horizontal PD was taken with a caliper adjacent to the cornea. Mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), and end-tidal CO, (etCO(2)) were also measured. All parameters were measured at TO, T30, T45, and T60 time points. One-way repeated measures ANOVA and the t-test were used to assess statistical differences (P < 0.05).Results T30, T45, and T60 TOP measures were Within normal limits for both groups and TOP did not differ between groups at any time. There was a significant decrease in PD in G I between TO and T30, T45 and T60, and also between T30 and T60. PD did not differ between groups. All vital parameters were within normal limits throughout anesthesia.Conclusions Administration of nitrous oxide with desflurane results in maintenance of normal TOP and prevents a decrease in horizontal PD during anesthesia. Therefore, this may be a suitable protocol in dogs undergoing intraocular surgeries that require mydriasis and maintenance of normal TOP.

Does sealing endotracheal tube cuff pressure diminish the frequency of postoperative laryngotracheal complaints after nitrous oxide anesthesia?

Study Objectives: To study endotracheal tube (ETT) cuff pressures during nitrous oxide (N2O) anesthesia when the cuffs are inflated with air to achieve sealing pressure, and to evaluate the frequency of postoperative laryngotracheal complaints.Design: Prospective, randomized, blind study.Setting: Metropolitan teaching hospital.Patients: 50 ASA physical status I and II patients scheduled for elective abdominal surgery.Interventions: Patients received standard general anesthesia with 66% N2O in oxygen. In 25 patients, the ETT cuff was inflated with air to achieve a sealing pressure (P-seal group). In 25 patients, the ETT cuff was inflated with air to achieve a pressure of 25 cm H2O (P-25 group).Measurements and Main Results: ETT intracuff pressures were recorded before (control) and at 30, 60, 90, 120, and 150 minutes during N2O administration. We investigated the frequency and intensity of sore throat, hoarseness, and dysphagia in patients in the Post-Anesthesia Care Unit (PACU) and 24 hours following tracheal extubation. The cuff pressures in the P-seal group were significantly lower than in the P-25 group at all time points studied (p < 0.001), with a significant increase with time in both groups (p < 0.001). The cuff pressures exceeded the critical pressure of 30 cm H2O only after 90 minutes in the P-seal group and already by 30 minutes in the P-25 group. The frequency and intensity of sore throat, hoarseness, and dysphagia were similar in both groups in the PACU and 24 hours after tracheal extubation (p > 0.05).Conclusions: Minimum ETT sealing cuff pressure during N2O anesthesia did not prevent, but instead attenuated, the increase in cuff pressure and did not decrease postoperative laryngotracheal complaints. (C) 2004 by Elsevier B.V.

Stable isotope investigations of atmospheric nitrous oxide

ZusammenfassungDie Analyse von Isotopenverhältnissen ist von wachsender Bedeutung bei der Untersuchung von Quellen, Senken und chemischen Reaktionswegen atmosphärischer Spurengase. Distickstoffoxid (N2O) hat vier isotopisch einfach substituierte Spezies: 14N15N16O, 15N14N16O, 14N217O und 14N218O. In der vorliegenden Arbeit wurden massenspektrometrische Methoden entwickelt, die eine komplette Charakterisierung der Variationen im Vorkommen dieser Spezies ermöglichen. Es wird die bisher umfassendste Darstellung dieser Variationen in Troposphäre und Stratosphäre gegeben und mit Bezug auf eine Reihe von Laborexperimenten detailliert interpretiert.Die Laborexperimente machen einen großen Anteil dieser Doktorarbeit aus und konzentrieren sich auf die Isotopenfraktionierung in den stratosphärischen N2O-Senken, d. h. Photolyse und Reaktion mit elektronisch angeregten Sauerstoffatomen, O(1D). Diese Prozesse sind von dominantem Einfluß auf die Isotopenzusammensetzung von atmosphärischem N2O. Potentiell wichtige Parameter wie Temperatur- und Druckvariationen, aber auch Veränderungen der Wellenlänge im Fall der Photolyse wurden berücksichtigt. Photolyse bei stratosphärisch relevanten Wellenlängen > 190 nm zeigte immer Anreicherungen von 15N in beiden Stickstoffatomen des verbleibenden N2O wie auch in 17O und 18O. Die Anreicherungen waren am mittelständigen N-Atom signifikant höher als am endständigen N (mit mittleren Werten für 18O) und stiegen zu größeren Wellenlängen und niedrigeren Temperaturen hin an. Erstmalig wurden für 18O und 15N am endständigen N-Atom Isotopenabreicherungen bei 185 nm-Photolyse festgestellt. Im Gegensatz zur Photolyse waren die Isotopenanreicherungen bei der zweiten wichtigen N2O-Senke, Reaktion mit O(1D) vergleichsweise gering. Jedoch war das positionsabhängige Fraktionierungsmuster dem der Photolyse direkt entgegengesetzt und zeigte größere Anreicherungen am endständigen N-Atom. Demgemäß führen beiden Senkenprozesse zu charakteristischen Isotopensignaturen in stratosphärischem N2O. Weitere N2O-Photolyseexperimente zeigten, daß 15N216O in der Atmosphäre höchstwahrscheinlich mit der statistisch zu erwartenden Häufigkeit vorkommt.Kleine stratosphärische Proben erforderten die Anpassung der massenspektrometrischen Methoden an Permanentflußtechniken, die auch für Messungen an Firnluftproben von zwei antarktischen Stationen verwendet wurden. Das 'Firnluftarchiv' erlaubte es, den gegenwärtigen Trend und die präindustriellen Werte der troposphärischen N2O-Isotopensignatur zu bestimmen. Ein daraus konstruiertes globales N2O-Isotopenbudget ist im Einklang mit den besten Schätzungen der Gesamt-N2O-Emissionen aus Böden und Ozeanen.17O-Messungen bestätigten die Sauerstoffisotopenanomalie in atmosphärischem N2O, zeigten aber auch, daß N2O-Photolyse die Sauerstoffisotope gemäß einem massenabhängigen Fraktionierungsgesetz anreichert. Eine troposphärische Ursache für einen Teil des Exzeß-17O wurde vorgeschlagen, basierend auf der Reaktion von NH2 mit NO2, wodurch die Sauerstoffisotopenanomalie von O3 über NO2 an N2O übertragen wird.

Challenges for simultaneous nitrification, denitrification, and phosphorus removal in microbial aggregates: mass transfer limitation and nitrous oxide production

The microbial community composition and activity was investigated in aggregates from a lab-scale bioreactor, in which nitrification, denitrification and phosphorus removal occurred simultaneously. The biomass was highly enriched for polyphosphate accumulating organisms facilitating complete removal of phosphorus from the bulk liquid; however, some inorganic nitrogen still remained at the end of the reactor cycle. This was ascribed to incomplete coupling of nitrification and denitrification causing NO3- accumulation. After 2 h of aeration, denitrification was dependent on the activity of nitrifying bacteria facilitating the formation of anoxic zones in the aggregates; hence, denitrification could not occur without simultaneous nitrification towards the end of the reactor cycle. Nitrous oxide was identified as a product of denitrification, when based on stored PHA as carbon source. This observation is of critical importance to the outlook of applying PHA-driven denitrification in activated sludge processes. (c) 2004 Federation of European Microbiological Societies. Published by Elsevier B.V. All rights reserved.