Should nitrous oxide be discontinued before desflurane after anaesthesia with desflurane/N2O?

Abstract

Background: The appearance of hypoxaemia immediately after anaesthesia with nitrous oxide may be partially explained by diffusion hypoxia. This study was undertaken to evaluate circulatory and respiratory variables during emergence after desflurane/nitrous oxide anaesthesia, and whether there are any differences depending on which gas is discontinued first.

Methods: 20 patients were studied after gynaecological laparoscopic surgery. The depth of anaesthesia was reduced 10 min prior to the emergence by stopping the administration of one of the two inhalational agents. Desflurane was discontinued first in Group 1, nitrous oxide in Group 2. Ventilation was controlled with E'CO2 maintained at 5% until the administration of the second anaesthetic gas was discontinued. Thereafter, the patients breathed spontaneously.

Results: The PaCO2 at which the respiratory drive reappeared after controlled normoventilation was similar in both groups, 6.1-6.5 kPa, and extubation was performed after 10-11 min. At extubation, the end-tidal CO2 and total MAC were similar in the groups, about 6.2 vol% and 0.16, respectively. Mean arterial blood pressure was significantly higher in Group 1. The cardiac output increased in both groups from about 6 l/min at the conclusion of anaesthesia to 9.0 and 7.6 l/min at 15 min in the recovery period. End-tidal O2 decreased and CO2 increased in both groups during the first 10 min in the recovery period. pH was reduced at 15 and 30 min in both groups.

Conclusion: Irrespective of which agent was discontinued first there was an increase in cardiac output decrease in oxygenation and a modest acidosis in the first 30-min recovery period. The only significant difference between the groups was in mean arterial blood pressure in the early emergence phase with a greater MAP when N2O had been used until the conclusion of anaesthesia.