Nitrous oxide and serious morbidity and mortality in the POISE trial

Anesth Analg. 2013 May;116(5):1034-40. doi: 10.1213/ANE.0b013e318270014a. Epub 2013 Jan 21.

Abstract

Background: In this post hoc subanalysis of the Perioperative Ischemic Evaluation (POISE) trial, we sought to determine whether nitrous oxide was associated with the primary composite outcome of cardiovascular death, nonfatal myocardial infarction (MI), and nonfatal cardiac arrest within 30 days of randomization.

Methods: The POISE trial of perioperative β-blockade was undertaken in 8351 patients. Nitrous oxide anesthesia was defined as the coadministration of nitrous oxide in patients receiving general anesthesia, with or without additional neuraxial blockade or peripheral nerve blockade. Logistic regression, with inverse probability weighting using estimated propensity scores, was used to determine the association of nitrous oxide with the primary outcome, MI, stroke, death, and clinically significant hypotension.

Results: Nitrous oxide was administered to 1489 (29%) of the 5133 patients included in this analysis. Nitrous oxide had no significant effect on the risk of the primary outcome (112 [7.5%] vs 248 [6.9%]; odds ratio [OR], 1.08; 95% confidence interval [CI], 0.82-1.44; 99% CI, 0.75-1.57; P = 0.58), MI (89 [6.0] vs 204 [5.6]; OR, 0.99; 95% CI, 0.75-1.31; 99% CI, 0.69-1.42; P = 0.94), stroke (6 [0.4%] vs 28 [0.8%]; OR, 0.85; 95% CI, 0.26-2.82; 99% CI, 0.17-4.11; P = 0.79), death (40 [2.7%] vs 100 [2.8%]; OR, 1.04; 95% CI, 0.6-1.81; 99% CI, 0.51-2.15; P = 0.88) or clinically significant hypotension (219 [14.7%] vs 544 [15.0%]; OR, 0.92; 95% CI, 0.74-1.15; 99% CI, 0.70-1.23; P = 0.48).

Conclusions: In this post hoc subanalysis, nitrous oxide was not associated with an increased risk of adverse outcomes in the POISE trial patients. This analysis was limited by the observational nature of the data and the lack of information on the concentration and duration of nitrous oxide administration. Further randomized controlled trial evidence is required.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Anesthesia, Inhalation / adverse effects
  • Anesthetics, Inhalation / adverse effects*
  • Confidence Intervals
  • Data Interpretation, Statistical
  • Double-Blind Method
  • Drug Utilization
  • Female
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
  • Intraoperative Complications / epidemiology*
  • Intraoperative Complications / mortality*
  • Logistic Models
  • Male
  • Middle Aged
  • Myocardial Infarction / epidemiology
  • Nitrous Oxide / adverse effects*
  • Odds Ratio
  • Perioperative Period / mortality*
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / mortality*
  • Preanesthetic Medication
  • Propensity Score
  • Sex Factors
  • Treatment Outcome

Substances

  • Anesthetics, Inhalation
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Nitrous Oxide