Topics:
nitrous oxide, pulmonary complications

In this issue of Anesthesiology, Peyton et al.1  present a valuable post hoc subanalysis of postoperative pulmonary complications in 2,328 randomized patients who participated in the Australian cohort of the Evaluation of Nitrous Oxide in the Gas Mixture for Anesthesia (ENIGMA) II trial.2  The incidence of postoperative atelectasis was significantly lower in patients randomized to 70% nitrous oxide and 30% oxygen at 171 of 1,169 patients (14.6%) than in those assigned to 70% nitrogen and 30% oxygen at 210 of 1,159 patients (18.1%), for an odds ratio of 0.77 in favor of nitrous oxide (95% CI, 0.62 to 0.97; P = 0.023). In contrast, the incidence of pneumonia was roughly comparable at 60 of 1,169 (5.1%) in nitrous oxide patients versus 52 of 1,159 (4.5%) in those assigned to nitrogen.

The ENIGMA II results appear robust, being based on more than 2,300 randomized patients and more than...

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