| JOURNAL HOME | CME HOME | THIS MONTH | PAST ISSUES | ETOC | COLLECTIONS |
| AUTHORS | REVIEWERS | EDITORIAL BOARD | FEEDBACK | RSS | HELP |
| ||||||||||||||
| ||||||||||||||
|
|
|
|
||||||||||||
|
||||||||||||||
Dept of Anesthesia & Intensive Care and Center for Clinical Research, Central Hospital, SE-721 89 Vasteras, Sweden
To the Editor:
The latest of several interesting reports from NH Badner and coworkers indicated that it was possible to block the nitrous oxide-induced increase in plasma homocysteine with a prophylactic vitamin B complex regimen (1).
Alternatively, perhaps nitrous oxide should be replaced with other analgesics and/or larger doses of other anesthetics, as was done in the treatment group who received on average a 0.2% higher end tidal isoflurane concentration (1).
In November 2000 we stopped all routine use of nitrous oxide at our department, with exceptions for C-section and some ENT procedures. In a staff questionnaire in May 2001, we found that more than half of the staff had not used nitrous oxide at all during the 6 month period, and another third had used the drug three times or less. Of those who had used nitrous oxide for other purposes than the mentioned exceptions, 48% judged the benefit from nitrous oxide inclusion to be minor. A majority, 93%, thought that our new strategy should continue, and we still do not use nitrous oxide routinely.
One advantage with nitrous oxide is that it is easy to use. It is tempting to suggest the low price to be an advantage. However, the direct costs for drugs are not the complete story in health econom-ics. The picture will change when taking all indirect costs into consideration, including the costs for all the side effects. If our Canadian colleagues manage to close the chain of nitrous oxide-homocysteine-postoperative ischemia, postoperative morbidity, and mortality, then we have the last nail to strike into the coffin of the dead nitrous oxide body. I wish Dr. Badner and coworkers good luck.
References
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
