大手术中笑气的应用思考.pptVIP

大手术中笑气的应用思考;Background; Evaluate whether avoidance of nitrous oxide, an intervention that avoids potential nitrous oxide toxicity and in addition allows an increase in the inspired oxygen fraction, could decrease the duration of hospital stay after surgery and reduce postoperative complications, nitrous oxide-free compared with a nitrous oxide–based anesthetic regimen in adult patients presenting for major surgery. ;Materials and Methods;Randomly (using a computer-generated code, accessed via an automated telephone voice recognition service) blind (patients, surgeons, research staff conducting the postoperative follow-ups) multicenter (19 participating sites around the world) Groups: nitrous oxide–free anesthesia( a gas mixture of 80% oxygen with 20% nitrogen) and nitrous oxide–based anesthesia( a gas mixture of 70% nitrous oxide with 30% oxygen from after induction of anesthesia to completion of surgery) Adjustment for age, ASA physical status, duration of anes.;Results;Results;Results;The median duration of ICU stay was 1 day in each group;Results;Patients in the nitrous oxide–free group had a lower incidence of several postoperative complications, including severe nausea or vomiting, fever, wound infection, pneumonia, and atelectasis. Were less likely to have at least one major complication. Patients in the nitrous oxide–free group had better quality of recovery scores than patients in the nitrous oxide group. And it was unaffected after adjustment for age, ASA, sex, etc.. The incidence of severe nausea or vomiting within 24 h of surgery in our study was reduced from 23% in the nitrous oxide group to 10% in the nitrous oxide–free group.;Effect of Inspired Oxygen concentration: no measurable effect of supplemental oxygen on hospital stay, ICU stay, wound infection , or severe nausea or vomiting, but there was a reduction in fever (P= 0.001). Effect of Preoperative Folate or Vitamin B Supplementation: no evidence that vitamin supplementation modified the e