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Which of the following concerning nitrous oxide and post operative nausea and vomiting is correct?
A. A propofol/nitrous oxide anesthetic has similar PONV rates as propofol alone
B. The addition of nitrous oxide to desflurane increases the incidence of PONV
C. The addition of nitrous oxide to sevoflurane increases the incidence of PONV
D. Nitrous oxide increases PONV via vestibular apparatus stimulation following diffusion into the middle ear
Answer
The answer is D. Nitrous will increase the incidence of PONV when added to propofol alone, but does NOT increase the incidence of PONV when added to sevoflurane and desflurane (halothane was different). So, from a nausea and vomiting prospective, there is not benefit to avoiding nitrous oxide when you are using sevoflurane or desflurane. Many of your attendings or colleagues will be surprised at this fact. Of course, this may be a little case specific, but at least in the these studies there was no difference. [1][2][3].
Notes
- ↑ Watcha, M. F., et al. "Effect of propofol on the incidence of postoperative vomiting after strabismus surgery in pediatric outpatients." Anesthesiology 75.2 (1991): 204-209.[1]
- ↑ Kuhn, I., G. Scheifler, and H. Wissing. "Incidence of nausea and vomiting in children after strabismus surgery following desflurane anaesthesia." Pediatric Anesthesia 9.6 (1999): 521-526.[2]
- ↑ Bortone, Luciano, Edoardo Picetti, and Mario Mergoni. "Anaesthesia with sevoflurane in children: nitrous oxide does not increase postoperative vomiting." Pediatric Anesthesia 12.9 (2002): 775-779.[3]
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