TYK258

Nitrous oxide use in neuroanesthesia is often employed to limit use of volatile agents to limit interference with neuromonitoring during surgery. However, its use is controversial. Which of the following statements regarding nitrous oxide use is INCORRECT?

a) It can be discontinued before closure of the dura to decrease the possibility of developing post-operative tension pneumocephalus

b) It can be continued to the end of the surgery to allow for a rapid awakening

c) Its use should be monitored closely as it increases CMRO2, CBF, and ICP

d) Its use should be discouraged completely because it has been shown to impair the developing brain of humans

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Answer

Answer d. Previous concerns for postoperative tension pneumocephalus with the use of nitrous oxide have been rebutted;39 N2O can safely be used for the entire surgery. A reasonable alternative is to discontinue its use just before closure of the dura. Because it increases CMRO2, CBF, and ICP,40,41,42 its use in conditions of decreased cerebral compliance should be closely monitored, especially if not counteracted by simultaneous hyperventilation.43 Nonetheless, some pediatric anesthesiologists avoid nitrous oxide altogether because of a concern for impairment in the developing brain of animals.44

Notes

This question originally printed in the Pediatric Anesthesiology Review Topics kindle book series, and appears courtesy of Naerthwyn Press, LLC.

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