Effect of nitrous oxide on neurologic and neuropsychological function after intracranial aneurysm surgery

Diana G McGregor; William L Lanier; Jeffrey J Pasternak; Deborah A Rusy; Kirk Hogan; Satwant Samra; Bradley Hindman; Michael M Todd; Darrell R Schroeder; Emine Ozgur Bayman; William Clarke; James Torner; Julie Weeks; Intraoperative Hypothermia for Aneurysm Surgery Trial Investigators

doi:10.1097/ALN.0b013e31816721fa

Effect of nitrous oxide on neurologic and neuropsychological function after intracranial aneurysm surgery

Anesthesiology. 2008 Apr;108(4):568-79. doi: 10.1097/ALN.0b013e31816721fa.

Authors

Diana G McGregor¹, William L Lanier, Jeffrey J Pasternak, Deborah A Rusy, Kirk Hogan, Satwant Samra, Bradley Hindman, Michael M Todd, Darrell R Schroeder, Emine Ozgur Bayman, William Clarke, James Torner, Julie Weeks; Intraoperative Hypothermia for Aneurysm Surgery Trial Investigators

Collaborators

Intraoperative Hypothermia for Aneurysm Surgery Trial Investigators:
M Todd, B Hindman, W Clarke, K Chaloner, J Torner, P Davis, M Howard, D Tranel, S Anderson, M Todd, B Hindman, J Weeks, L Moss, J Winn, W Clarke, K Chaloner, M Wichman, R Peters, M Hansen, D Anderson, J Lang, B Yoo, H Adams, G Clifton, A Gelb, C Loftus, A Schubert, D Warner, W Young, R Frankowski, K Kieburtz, D Prough, L Sternau, J Marler, C Moy, B Radziszewska, B Matta, P Kirkpatrick, D Chatfield, C Skilbeck, R Kirollos, F Rasulo, K English, C Duffy, K Pedersen, N Scurrah, R Burnstein, A Prabhu, C Salmond, A Blackwell, J Birrell, S Jackson, N Kassell, T Pajewski, H Fraley, A Morris, T Alden, M Shaffrey, D Bogdonoff, M Durieux, Z Zuo, K Littlewood, E Nemergut, R Bedford, D Stone, P Balestrieri, J Mason, G Henry, P Ting, J Shafer, T Blount, L Kim, A James, E Farace, L Clark, M Irons, T Sasaki, K Webb, T Short, E Mee, J Ormrod, J Jane, T Alden, P Heppner, S Olson, D Ellegala, C Lind, J Sheehan, M Woodfield, A Law, M Harrison, P Davies, D Campbell, N Robertson, R Fry, D Sage, S Laurent, C Bradfield, K Pedersen, K Smith, Y Young, C Chambers, B Hodkinson, J Biddulph, L Jensen, J Ogden, Z Thayer, F Lee, S Crump, J Quaedackers, A Wray, V Roelfsema, R Greif, G Kleinpeter, C Lothaller, E Knosp, W Pfisterer, R Schatzer, C Salem, W Kutalek, E Tuerkkan, L Koller, T Weber, A Buchmann, C Merhaut, M Graf, B Rapf, A Lam, D Newell, P Tanzi, L Lee, K Domino, M Vavilala, J Bramhall, M Souter, G Britz, H Winn, H Bybee, St Vincent, T Costello, M Murphy, K Harris, C Thien, D Nye, T Han, P McNeill, B O’Brien, J Cormack, A Wyss, R Grauer, R Popovic, S Jones, R Deam, G Heard, R Watson, L Evered, F Bardenhagen, C Meade, J Haartsen, J Kruger, M Wilson, M Maktabi, V Traynelis, A McAllister, P Leonard, B Hindman, J Brian, F Mensink, R From, D Papworth, P Schmid, D Dehring, M Howard, P Hitchon, J VanGilder, J Weeks, L Moss, K Manzel, S Anderson, R Tack, D Taggard, P Lennarson, M Menhusen, A Gelb, S Lownie, R Craen, T Novick, G Ferguson, N Duggal, J Findlay, W Ng, D Cowie, N Badner, I Herrick, H Smith, G Heard, R Peterson, J Howell, L Lindsey, L Carriere, M von Lewinski, B Schaefer, D Bisnaire, P Doyle-Pettypiece, M McTaggart, S Giannotta, V Zelman, E Thomson, E Babayan, C McCleary, D Fishback, S Samra, B Thompson, W Chandler, J McGillicuddy, K Tremper, C Turner, P Smythe, E Dy, S Pai, V Portman, J Palmisano, D Auer, M Quigley, B Giordani, A Freymuth, P Scott, R Silbergleit, S Hickenbottom, L Litt, M Lawton, L Hannegan, D Gupta, P Bickler, B Dodson, P Talke, I Rampil, B Chen, P Wright, J Mitchell, S Ryan, J Walker, N Quinnine, C Applebury, P Myles, J Rosenfeld, J Hunt, S Wallace, P D’Urso, C Thien, J McMahon, S Wadanamby, K Siu, G Malham, J Laidlaw, S Salerno, S Alatakis, H Madder, S Cairo, A Konstantatos, J Smart, D Lindholm, D Bain, H Machlin, J Moloney, M Buckland, A Silvers, G Downey, A Molnar, M Langley, D McIlroy, D Daly, P Bennett, L Forlano, R Testa, W Burnett, F Johnson, M Angliss, H Fletcher, P Manninen, M Wallace, K Lukitto, M Tymianski, P Porter, F Gentili, H El-Beheiry, M Mosa, P Mak, M Balki, S Shaikh, R Sawyer, K Quader, R Chelliah, P Berklayd, N Merah, G Ghazali, M McAndrews, J Ridgley, O Odukoya, S Yantha, J Wilson, P Petrozza, C Miller, K O’Brien, C Tong, M Olympio, J Reynolds, D Colonna, S Glazier, S Nobles, D Hill, H Hulbert, W Jenkins, W Lanier, D Piepgras, R Wilson, F Meyer, J Atkinson, M Link, M Weglinski, K Berge, D McGregor, M Trenerry, G Smith, J Walkes, M Felmlee-Devine, H Van Aken, C Greiner, H Freise, H Brors, K Hahnenkamp, N Monteiro de Oliveira, C Schul, D Moskopp, J Woelfer, C Hoenemann, H Gramke, H Bone, I Gibmeier, S Wirtz, H Lohmann, J Freyhoff, B Bauer, K Hogan, R Dempsey, D Rusy, B Badie, B Iskandar, D Resnick, P Deshmukh, J Fitzpatrick, F Sasse, T Broderick, K Willmann, L Connery, J Kish, C Weasler, N Page, B Hermann, J Jones, D Dulli, H Stanko, M Geraghty, R Elbe, F Salevsky, R Leblanc, N Lapointe, H MacGregor, D Sinclair, D Sirhan, M Maleki, M Abou-Madi, D Chartrand, M Angle, D Milovan, Y Painchaud, M Mirski, R Tamargo, S Rice, A Olivi, D Kim, D Rigamonti, N Naff, M Hemstreet, L Berkow, P Chery, J Ulatowski, L Moore, T Cunningham, N McBee, T Hartman, J Heidler, A Hillis, E Tuffiash, C Chase, A Kane, D Greene-Chandos, M Torbey, W Ziai, K Lane, A Bhardwaj, N Subhas, A Schubert, M Mayberg, M Beven, P Rasmussen, H Woo, S Bhatia, Z Ebrahim, M Lotto, F Vasarhelyi, J Munis, K Graves, J Woletz, G Chelune, S Samples, J Evans, D Blair, A Abou-Chebl, F Shutway, D Manke, C Beven, P Fogarty-Mack, P Stieg, R Eliazo, P Li, H Riina, C Lien, L Ravdin, J Wang, Y Kuo, R Jaffe, G Steinberg, D Luu, S Chang, R Giffard, H Lemmens, R Morgan, A Mathur, M Angst, A Meyer, H Yi, P Karzmark, T Bell-Stephens, M Marcellus, J Sneyd, L Pobereskin, S Salsbury, P Whitfield, R Sawyer, A Dashfield, R Struthers, P Davies, A Rushton, V Petty, S Harding, E Richardson, H Yonas, F Gyulai, L Kirby, A Kassam, N Bircher, L Meng, J Krugh, G Seever, R Hendrickson, J Gebel, D Cowie, G Fabinyi, S Poustie, G Davis, A Drnda, D Chandrasekara, J Sturm, T Phan, A Shelton, M Clausen, S Micallef, A Sills, F Steinman, P Sutton, J Sanders, D Van Alstine, D Leggett, E Cunningham, W Hamm, B Frankel, J Sorenson, L Atkins, A Redmond, S Dalrymple, S Black, W Fisher, C Hall, D Wilhite, T Moore 2nd, P Blanton, Z Sha, P Szmuk, D Kim, A Ashtari, C Hagberg, M Matuszczak, A Shahen, O Moise, D Novy, R Govindaraj, L Jameson, R Breeze, I Awad, R Mattison, T Anderson, L Salvia, M Mosier, C Loftus, J Smith, W Lilley, B White, M Lenaerts

Affiliation

¹ Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.

PMID: 18362587
DOI: 10.1097/ALN.0b013e31816721fa

Abstract

Background: Laboratory studies suggest that nitrous oxide augments brain injury after ischemia or hypoxia. The authors examined the relation between nitrous oxide use and outcomes using data from the Intraoperative Hypothermia for Aneurysm Surgery Trial.

Methods: The Intraoperative Hypothermia for Aneurysm Surgery Trial was a prospective randomized study of the impact of intraoperative hypothermia (temperature = 33 degrees C) versus normothermia (temperature = 36.5 degrees C) in patients with aneurysmal subarachnoid hemorrhage undergoing surgical clipping. Anesthesia was dictated by a limited-options protocol with the use of nitrous oxide determined by individual anesthesiologists. All patients were assessed daily for 14 days after surgery or until hospital discharge. Neurologic and neuropsychological testing were conducted at 3 months after surgery. Outcome data were analyzed via both univariate tests and multivariate logistic regression analysis correcting for factors thought to influence outcome. An odds ratio (OR) greater than 1.0 denotes a worse outcome in patients receiving nitrous oxide.

Results: Outcome data were available for 1,000 patients, of which 373 received nitrous oxide. There was no difference between groups in the development of delayed ischemic neurologic deficit. At 3 months after surgery, there were no significant differences between groups in any outcome variable: Glasgow Outcome Score (OR, 0.84; 95% confidence interval [CI], 0.63-1.14; P = 0.268), National Institutes of Health Stroke Scale (OR, 1.29; 95% CI, 0.96-1.73; P = 0.087), Rankin Disability Score (OR, 0.84; 95% CI, 0.61-1.15; P = 0.284), Barthel Activities of Daily Living Index (OR, 1.01; 95% CI, 0.68-1.51; P = 0.961), or neuropsychological testing (OR, 1.26; 95% CI, 0.85-1.87; P = 0.252).

Conclusions: In a population of patients at risk for ischemic brain injury, nitrous oxide use had no overall beneficial or detrimental impact on neurologic or neuropsychological outcomes.

Publication types

Comparative Study
Research Support, N.I.H., Extramural

MeSH terms

Adult
Aged
Female
Follow-Up Studies
Humans
Hypothermia, Induced / methods
Intracranial Aneurysm / pathology
Intracranial Aneurysm / psychology*
Intracranial Aneurysm / surgery*
Male
Middle Aged
Multicenter Studies as Topic / methods
Nervous System Diseases / chemically induced*
Nervous System Diseases / pathology
Nervous System Diseases / psychology*
Neuropsychological Tests
Nitrous Oxide / adverse effects*
Prospective Studies
Randomized Controlled Trials as Topic / methods
Subarachnoid Hemorrhage / pathology
Subarachnoid Hemorrhage / psychology
Subarachnoid Hemorrhage / surgery

Substances

Nitrous Oxide

Grants and funding

R01 NS38554/NS/NINDS NIH HHS/United States