„Lachgas heute - eine klinische Wertung auf dem Boden der Literatur”

A. Rothhammer

doi:10.1055/s-2002-32702

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Anästhesiol Intensivmed Notfallmed Schmerzther 2002; 37(7): 375-377
DOI: 10.1055/s-2002-32702

Der besondere Beitrag

„Lachgas heute - eine klinische Wertung auf dem Boden der Literatur”

Nitrous Oxide Today - a Literature Based Clinical EvidenceA. Rothhammer

¹Institut für Anaesthesiologie und Intensivmedizin der Leopoldina Krankenhaus gGmbH

Herrn Professor Dr. K. H. Weis zum 75. Geburtstag

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Publication History

Publication Date:
08 July 2002 (online)

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Einleitung

Die lachgasfreie Anästhesie galt über Jahrzehnte als Methode zweiter Wahl und war auf wenige, durch klare Kontraindikationen erzwungene Gelegenheiten begrenzt. Dieser obligate Platz in fast jeder Allgemeinanästhesie ging in den letzten Jahren verloren, da neue Pharmaka den Verzicht auf Lachgas erleichtern und seine Anwendung im konsequenten Niedrigfluss vermehrte Aufmerksamkeit erfordert [1] [2]. Dies erklärt zusammen mit insgesamt verminderten Frischgasflüssen die Abnahme des Verbrauches an medizinischem Stickoxydul in Deutschland um bis zu zehn Prozent seit 1998 (Angaben deutscher Hersteller, persönliche Mitteilungen). Darüber hinaus betonten einige „Vorreiter” die Gefahren von Lachgas und bezeichneten Lachgas als obsolet [3]. Die daraus resultierende, von Schulte am Esch als „zum Teil emotional geführte Trenddiskussion” [4] bezeichnete Auseinandersetzung sollte nun einer sachlichen Abwägung „mit Augenmaß” auf dem Boden des heutigen Kenntnisstandes weichen, um den Stellenwert von Lachgas in der heutigen Praxis anästhesiologisch, anwenderbezogen und ökonomisch verantwortlich zu bestimmen und Verunsicherung zu vermeiden. Hierzu ist es wieder einmal an der Zeit, den Kenntnisstand über Wirkungen und Nebenwirkungen von Lachgas darzustellen und vor dem Hintergrund der Alternativen zu werten.

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1 Anmerkung der Schriftleitung
Dieser Beitrag von A. Rothhammer bezieht sich auf das Mini-Symposium „200 Jahre Lachgas - Auch das Ende einer Ära?” in Heft 10, 2001, S. 640 - 651 und greift dieses Thema erneut auf.

Appendix I

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123 Vetter T R. A comparison of EMLA cream versus nitrous oxide for pediatric venous cannulation. I Clin Anesth. 1995; 7 85-490 , N₂O besser als EMLA

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Appendix III

145 Lorenz I H, Kolbitsch C, Hörmann C, Luger T J, Schocke M, Felber S, Zschiegner F, Hinteregger M, Kremser C, Benzer A. Influence of equianaesthetic concentrations of nitrous oxide and isoflurane on regional cerebral blood flow, regional cerebral blood volume, and regional mean transit time in human volunteers. Brit J Anaesth. 2001; 87 691-698 , 45 % N₂O ändern nur gering Verteilung des CBF

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146 Reinstrup P, Ryding E, Ohlsson T, Dahm P L, Uski T. Cerebral blood volume (CBV) in humans during normo- and hypocapnia. Anesthesiol. 2001; 95 1079-1082 , 50 % N₂O ändern das cerebrale Blutvolumen nicht

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147 Aono M, Sato J, Nishino T. Nitrous oxide increases normocapnic cerebral blood flow velocity but does not affect the dynamic cerebrovascular response to step changes in endtidal PCO₂ in humans. Anesth Analg. 1999; 89 684-689 , N₂O hat Wenig Einfluss auf cerebrale Regulation

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148 Girling K J, Cavill G, Mahajan R P. The effects of nitrous oxide and oxygen on transient hyperemic response in human volunteers. Anesth Analg. 1999; 89 175-180 , Verringerte Autoregulation?

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150 Amorim P. Nitrous oxide in neuroanaesthesia. Eur J Anaes. 1998; 15S17 23-24 , N₂O erhöht CMRO2

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151 Bedforth N M, Girling K J, Harrison J M, Mahajan R P. Effects of sevoflurane with and without nitrous oxide on cerebral autoregulation as assessed by the transient hyperaemic response test. Br J Anaesth. 1998; 80 557-558 P , N₂O erhöht CBFV

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152 Kinney M S, Free J PH. Cardiovascular effects of 50% nitrous oxide in older adult patients anaesthetized with isoflurane or halothan. Br J Anaesth. 1998; 80 169-173 , Mit N₂O stabiler Kreislauf

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154 Girling K J, Cavill G, Dwyer G, Mahajan R P. Effect of 100 % oxygen and 50 % nitrous oxide on cerebral autoregulation as assessed by the transient hyperaemic response test. Br J Anaest. 1997; 79 131 P , N₂O reduziert Autoregulation

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155 Inada T, Inada K, Kawachi S, Takubo K, Tai M, Yasugi H. Haemodynamic comparison of sevoflurane and isoflurane anaesthesia in surgical patients. Can J Anaesth. 1997; 44 140-145 , Mit N₂O weniger Kreislaufeffekte durch Sevoflurane oder Isoflurane

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156 Marsch S CU, Dalmas S, Philbin D M, Ryder W A, Wong L SS, Foex P. Effects and interactions of nitrous oxide myocardial ischemia and reperfusion on left ventricular diastolic function. Anaesth Analg. 1997; 84 39-45 , N₂O vermindert diastolische Funktion

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157 Reinstrup P, Ryding E, Algotsson L, Berntman L, Uski T. Regional cerebral blood flow (SPECT) during anaesthesia with isoflurane and nitrous oxide. Br J Anaesth. 1997; 78 407-411 , N₂O erhöht CBF

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158 Cho S, Fujigaki T, Uchiyama Y, Fukusaki M, Shibata O, Sumikawa K. Effects of Sevoflurane with and without nitrous oxide on human cerbral circulation. Anesthesiol. 1997; 85 755-760 , Sevoflurane und N₂O haben keinen Einfluß auf CBF

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159 Hörmann C h, Schmidauer C h, Haring H P, Schalows S, Seiwald M, Benzer A. Hyperventilation reverses the nitrous oxide induced increase in cerebral blood flow velocity in human volunteers. Br J Anaesth. 1995; 74 616-618 , Kein N₂O-Effekt auf Autoregulation

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160 Houltz E, Caidahl K, Hellström A, Gustavsson T, Milocco I, Rickstein S E. The effects of nitrous oxide on left ventricular systolic and diastolic performance by computer-assisted twodimensional and Doppler echocardiography in patients undergoing coronary artery surgery. Anesth Analg. 1995; 81 243-248 , N₂O macht Dyskinesien nach cardiopulmonalem Bypass

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163 Marsch S CU, Philbin D M, Dalmas S, Ryder W A, Foex P. Effects of nitrous oxide on left ventricular diastolic function. Anesthesiol. 1994; 81 A 657 , Geringe N₂O-Wirkung auf Herz

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168 Eng C, Lam A, Mayberg T, Mathison T, Lee C. The influence of propofol with and without nitrous oxide on cerebral blood flow velocity and C02 reactivity in man. Anesth Analg. 1992; 74 S87 , Mit Propofol zeigt N₂O keine Wirkung aud CBF

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169 Eng C, Lam A M, Mayberg T S, Lee C, Mathisen I. The influence of propofol with and without nitrous oxide on cerebral blood flow velocity and CO₂ reactivity in humans. Anesthesiol. 1992; 77 872-879 , Mit Propofol zeigt N₂O keine Wirkung auf CBF

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170 Siker D, Pagel P S, Pelc L R, Kampine J P, Schmeling W T, Warltier D C. Nitrous oxide impairs functional recovery of stunned myocardium in barbiturate-anesthetized, acutely instrumented dogs. Anesth Analg. 1992; 75 539-548 , N₂O vermindert Erholung von Ischämie

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171 Westling F, Milsom K, Zetterström H, Ekström-Jodal B. Effects of nitrous oxide/oxygen inhalation on the maternal circulation during vaginal delivery. Acta An Scand. 1992; 36 175-181 , N₂O mildert Kreislaufreaktion bei Partus

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174 Nathan H J. Nitrous oxide does not worsen myocardial ischaemia following beta-receptor blockade in isoflurane anaesthetized dogs. Can J Anaesth. 1991; 38 640-647 , N₂O verstärkt Ischämie nicht unter Betablockade

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175 Stowe D F, Monroe S M, Marijic J, Bosniak Z J, Kampine J P. Comparison of halothane, enflurane, and isoflurane with nitrous oxide on contractility and oxygen supply and demand in insolated hearts. Anesthesiol. 1991; 75 1062-1074 , O₂-Bilanz in Kombination mit N₂O unverändert

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176 Sullivan P J, Miller O R, Martineau R J, Hull K A. A comparison of the cardiovascular effects of alfentanil nitrous oxide vs alfentanil-isoflurane anaesthesia. Can J Anaesth. 1991; 38 SA19 , N₂O wenig Effekt

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177 Lawson D, Frazer M J, Lynch I II. Nitrous oxide effects on isolated myocardium: a reexamination in vitro. Anesthesiol. 1990; 73 930-943 , N₂O senkt gering Kontraktilität

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178 Stowe D F, Monroe S M, Marijic J, Rooney R T, Bosnjak Z J, Kampine J P. Effects of nitrous oxide on contractile function and metabolism of the isolated heart. Anesthesiol. 1990; 73 1220-1226 , N₂O senkt gering Kontraktilität

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179 Pagel P S, Kampine J P, Schmeling W T, Warltier D C. Effects of nitrous oxide on myocardial contractility as evaluated by the preload recruitable stroke work relationship in chronically instrumented dogs. Anesthesiol. 1990; 73 1148-1157 , N₂O senkt Kontraktibilität, besonders mit Opiaten

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180 Chalan M K, Prakash O, Rulf E NR, Cahalan M T, Mayala A PG, Lurz F C, Rosseel P, Lachitjaran E, Siphanto K, Gussenhoven E J, Roelant J RTC. Addition of nitrous oxide to fentanyl anesthesia does not induce myocardial ischemia in patients with ischemic heart disease. Anesthesiol. 1987; 67 925-929 , Keine N₂O-Wirkung bei KHK unter Betablocker

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181 Kling D, Russ W, Boldt J, Hempelmann G. Lachgas: Zur Beeinflussung der Hämodynamik bei Patienten mit koronarer Herzkrankheit. AIN. 1987; 22 128-132 , Bei guter Ventrikelfunktion kein Effekt

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182 Roizen M F, Plummer G O, Lichtor J L. Nitrous oxide and dysrhythmias. Anesthesiol. 1987; 66 427-431 , N₂O macht evtl. AV-Knotenrhythmus

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183 Sessler D I, Rubinstein E H, Eger E I. Core temperature changes during N20 fentanyl and halothane 02 anesthesia. Anesthesiol. 1987; 67 137-139 , Mit N₂O weniger Auskühlung als bei Halothan O₂

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184 Wilkowski D AW, Still J C, Bonta W, Owen R, Bove A A. Nitrous oxide constricts epicardial coronary arteries without effect on coronary arterioles. Anesthesiol. 1987; 66 659-665 , Keine Wirkung auf Coronarfluß

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185 Eisele J H, Milstein J M, Goetzman B W. Pulmonary vascular responses to nitrous oxide in newborn lambs. Anesth Analg. 1986; 65 62-64 , N₂O erhöht PVR

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186 Hickey P R, Hansen D D, Strafford M, Thompson J E, Jonas R E, Mayer J E. Pulmonary and systemic hemodynamic effects of nitrous oxide in infants with normal and elevated pulmonary vascular resistance. Anesthesiol. 1986; 65 374-378 , N₂O bei grenzwertiger Funktion vermeiden

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187 Ramsay J G, Arvieux C C, Foex P, Philbin D M, Jeavons P, Ryder W A, Jones L A. Regional and global myocardial function in the dog when nitrous oxide is added to halothane in the presence of critical coronary artery constriction. Anesth Analg. 1986; 65 431-436 , N₂O bei grenzwertiger Funktion fraglich

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188 Seyde W C, Ellis J E, Longnecker D E. The addition of nitrous oxide to halothane decreases renal and splanchnic flow and increases cerebral blood flow in rats. Br J Anaesth. 1986; 58 63-68 , Flow-Umverteilung: CBF - Niere - Darm

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189 Slavik J R, La M antia, Kopriva C J, Prokop E K, Ezekowitz M D, Barash P C. Does N₂O cause regional wall motion abnormalities in patients with CAD? An evaluation by 2D transesophageal echocardiography. Anesthesiol. 1986; 65 A515 , Keine Wirkung auf Herzwandbewegung

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Appendix IV

190 Goto T, Nakata Y, Saito H, Ishiguro Y, Niimi Y, Morita S. The midlatency auditory evoked potentials predict responsiveness to verbal commands in patients emerging from anesthesia with xenon, isoflurane and sevoflurane but not with nitrous oxide. Anesthesiol. 2001; 94 782-789 , MLAEP durch N₂0 kaum verändert

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191 Hans P, Bonhomme V, Benmansour H, Dewandre P Y, Brichant J F, Lamy M. Effect of nitrous oxide on the bispectral index and the 95 % spectral edge frequency of the electroencephalogram during surgery. Anaesthesia. 2001; 56 999-1002 , N₂O senkt BIS durch Analgesie

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194 Iijima T, Nakamura Z, Iwao Y, Sankawa H. The epileptogenic properties of the volatile anesthetics Sevoflurane and isoflurane in patients with epiplepsy. Anesth Analg. 2000; 91 989-995 , 50 % N₂O unterdrücken Spikes bei Epileptikern unter Sevoflurane

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Appendix V

232 Foschi D, Rizzi A, Zighetti M L, Bissi M, Corsi F, Trabucchi E, Mezzetti M, Cattaneo M. Effects of surgical stress and nitrous oxide anaesthesia on perioperative plasma levels of total homocysteine. Anaesthesia. 2001; 56 676-679 , 70 % N₂O erhöhen Homocystein nicht

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235 Hoerauf K H, Schrögendorfer K F, Wiesner G, Gruber M, Spacek A, Kress H-G, Rüdiger H W. Sister chromatid exchange in human lymphocytes exposed to isoflurane and nitrous oxide in vitro. Br J Anaesth. 1999; 82 268-270 , N₂O bei MAK ohne Bedeutung

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237 Badner N H, Beattie S, Spence J D. Effects of intraoperative nitrous oxide on post operative homocysteine and myocardiac surgery. Anesth Analg. 1999; 88 SCA 59 , N₂O erhöht Homocystein

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241 Wiesner G, Hoerauf K H, Schroegendorfer K, Weindlmayr-Goettel M, Rüdiger H W, Taeger K. Does isoflurane or nitrous oxid induce micronuclei in human lymphocytes in vitro?. Br J Anaesth. 1998; 80S1 A318 , Mikronukleoli durch N₂O erhöht bei N₂O-Exponierten

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256 Nunn J F, Sharer N M, Bottiglieri T, Rossiter J. Effect of short-term administration of nitrous oxide on plasma concentrations of methionine, tryptophan, phenylalanine and S-Adenosyl methionine in man. Br J Anaesth. 1986; 58 1-10 , N₂O senkt Aminosäurespiegel

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Appendix VI

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260 Mallinder P A, Hall J, Bergin G, Royle P, Leaper D J. Influence of epidural and opiate, with and without nitrous oxide on postoperative bowel function. Eur J Anaesth. 2000; 17 (S19) A-352 , N₂O senkt intraoperativen Blutverlust, ist aber ohne Einfluss auf 1. Flatus

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269 Overdyk F J, Roy R C. If nitrous oxide induces emesis, maybe 100 % oxygen is an antiemetic. Anesth Analg. 1997; 84 231-232 , Keine sichere emetische Wirkung von N₂O

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270 Spinter W, Komocar L. Nitrous oxide does not increase vomiting after dental restorations in children. Anesth Analg. 1997; 84 506-508 , N₂O erhöht PONV nicht bei Kindern

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271 Thang J, Chen L, White P F, Wang B, Kariger R, Wender R H. Use of propofol for office-based anesthesia: effects of nitrous oxide. Anesthesiol. 1997; 87 A 9 , Mit Propofol keine Erhöhung von PONV durch N₂O

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275 Divatia J V, Vaidya J S, Badwe R A, Hawaldar R W. Omission of nitrous oxide during anesthesia reduces the incidence of postoperative nausea and vomiting. A Meta-Analysis. Anesthesiol. 1996; 85 1055-1062 , N₂O erhöht PONV bei Frauen, Opiat und Gyn. OP

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276 Hartung J. Twenty-four of twenty-seven studies show a greater incidence of emesis with nitrous oxide than with alternative anesthetics. Anesth Analg. 1996; 83 114-116 , N₂O erhöht PONV

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277 Hein H AT, Joshi G P, Stewart F, Ramsay K J, Ramsay M AE. The use of nitrous oxide increases the incidence of nausea and vomiting following middle ear surgery. Anesthesiol. 1996; 85 1009 , N₂O erhöht PONV bei Mittelohr-OP

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279 Tramer M, Moore A, Mc Q uay. Omitting nitrous oxide in general anaesthesia: meta-analysis of intraoperative awareness and postoperative emesis in randomized controlled trials. Br J Anaesth. 1996; 76 186-193 , N₂O erhöht PONV bei hohem Emesis-Risiko, senkt intraop.Wachheit!

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281 Alexander G, Bellefleur J, Brown M. The role of nitrous oxide in postoperative nausea and vomiting with desflurane and isoflurane. Anesthesiol. 1995; 83 A27 , N₂O erhöht PONV bei lapsk. TL

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282 Hartung J. Nitrous oxide increases the incidence of emesis. Anesth Analg. 1995; 80 S173 , N₂O erhöht PONV

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283 Pandit U A, Malviya S, Lewis J. Vomiting after outpatient tonsillectomy and adenectomy in children: The role of nitrous oxide. Anesth Analg. 1995; 80 230-233 , N₂O ohne Wirkung auf PONV bei ATE

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287 Sung Y F. Does nitrous oxide (N₂O) cause postoperative nausea and vomiting?. Anesth Analg. 1992; 74 (2) S311 , N₂O ohne emetische Wirkung

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288 Watcha M F, White P F. Postoperative nausea and vomiting. Anesthesiol. 1992; 77 62-184 , N₂O erhöht PONV nicht

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289 Korttila K, Hovorka J, Erkola O. Nitrous oxide does not increase the incidence of nausea and vomiting after isoflurane anesthesia. Anesth Analg. 1987; 66 761-765 , N₂O erhöht PONV nicht

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290 Melnick B M, Johnson L S. Effects of elminating nitrous oxide in outpatient anesthesia. Anesthesiol. 1987; 76 982-984 , Ohne N₂O weniger PONV

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Appendix VII

292 Reinelt H, Marx T, Schirmer U, Luederwald S, Topalidis P, Schmidt M. Diffusion of Xenon and nitrous oxide into the bowel during mechanical ileus. Anesthesiol. 2002; 96 512-513 , N₂O verdoppelt Gasvolumen intraluminal

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293 Combes X, Schauvliege F, Peyrouset O, Motamed C, Kirov K, Dhonneur G, Duvaldestin P. Intracuff pressure and tracheal morbidity Inluence of filling cuff with saline during nitrous oxide anesthesia. Anesthesiol. 2001; 95 1120-1124 , Ohne Cuffdruckkontrolle führt N₂O zu Mukosaläsionen der Trachea

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294 Karasawa F, Mori T, Kawatani Y, Ohshima T, Satoh I. Deflationary phenomenon of the nitrous oxide filled endotracheal tube cuff after cessation of nitrous oxide administration. Anesth Analg. 2001; 92 145-148 , Mit N₂O geblockte Tuben verlieren Druck bei 100 % O₂-Atmung

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Prof. Dr. A. Rothhammer

Institut für Anaesthesiologie und Intensivmedizin der Leopoldina
Krankenhaus gGmbH

Gustav-Adolf-Straße 8

97422 Schweinfurt