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Effect of nitrous oxide use on long-term neurologic and neuropsychological outcome in patients who received temporary proximal artery occlusion during cerebral aneurysm clipping surgery.

Publication ,  Journal Article
Pasternak, JJ; McGregor, DG; Lanier, WL; Schroeder, DR; Rusy, DA; Hindman, B; Clarke, W; Torner, J; Todd, MM; IHAST Investigators,
Published in: Anesthesiology
March 2009

BACKGROUND: The authors explored the relationship between nitrous oxide use and neurologic and neuropsychological outcome in a population of patients likely to experience intraoperative cerebral ischemia: those who had temporary cerebral arterial occlusion during aneurysm clipping surgery. METHODS: A post hoc analysis of a subset of the data from the Intraoperative Hypothermia for Aneurysm Surgery Trial was conducted. Only subjects who had temporary arterial occlusion during surgery were included in the analysis. Metrics of short-term and long-term (i.e., 3 months after surgery) outcome were evaluated via both univariate and multivariate logistic regression analysis. An odds ratio (OR) greater than 1.0 denotes a worse outcome in patients receiving nitrous oxide. RESULTS: The authors evaluated 441 patients, of which 199 received nitrous oxide. Patients receiving nitrous oxide had a greater risk of delayed ischemic neurologic deficits (i.e., the clinical manifestation of vasospasm) (OR, 1.78, 95% confidence interval [CI], 1.08-2.95; P = 0.025). However, at 3 months after surgery, there was no difference in any metric of gross neurologic outcome: Glasgow Outcome Score (OR, 0.67; CI, 0.44-1.03; P = 0.065), Rankin Score (OR, 0.74; CI, 0.47-1.16; P = 0.192), National Institutes of Health Stroke Scale (OR, 1.02; CI, 0.66-1.56; P = 0.937), or Barthel Index (OR, 0.69; CI, 0.38-1.25; P = 0.22). The risk of impairment on at least one test of neuropsychological function was reduced in those who received nitrous oxide (OR, 0.56; CI, 0.36-0.89; P = 0.013). CONCLUSION: In this patient population, use of nitrous oxide was associated with an increased risk for the development of delayed ischemic neurologic deficits; however, there was no evidence of detriment to long-term gross neurologic or neuropsychological outcome.

Duke Scholars

Published In

Anesthesiology

DOI

EISSN

1528-1175

Publication Date

March 2009

Volume

110

Issue

3

Start / End Page

563 / 573

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surgical Instruments
  • Prospective Studies
  • Postoperative Complications
  • Nitrous Oxide
  • Neurosurgical Procedures
  • Neuropsychological Tests
  • Nervous System Diseases
  • Middle Aged
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
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Pasternak, J. J., McGregor, D. G., Lanier, W. L., Schroeder, D. R., Rusy, D. A., Hindman, B., … IHAST Investigators, . (2009). Effect of nitrous oxide use on long-term neurologic and neuropsychological outcome in patients who received temporary proximal artery occlusion during cerebral aneurysm clipping surgery. Anesthesiology, 110(3), 563–573. https://doi.org/10.1097/ALN.0b013e318197ff81
Pasternak, Jeffrey J., Diana G. McGregor, William L. Lanier, Darrell R. Schroeder, Deborah A. Rusy, Bradley Hindman, William Clarke, James Torner, Michael M. Todd, and Michael M. IHAST Investigators. “Effect of nitrous oxide use on long-term neurologic and neuropsychological outcome in patients who received temporary proximal artery occlusion during cerebral aneurysm clipping surgery.Anesthesiology 110, no. 3 (March 2009): 563–73. https://doi.org/10.1097/ALN.0b013e318197ff81.
Pasternak, Jeffrey J., et al. “Effect of nitrous oxide use on long-term neurologic and neuropsychological outcome in patients who received temporary proximal artery occlusion during cerebral aneurysm clipping surgery.Anesthesiology, vol. 110, no. 3, Mar. 2009, pp. 563–73. Pubmed, doi:10.1097/ALN.0b013e318197ff81.
Pasternak JJ, McGregor DG, Lanier WL, Schroeder DR, Rusy DA, Hindman B, Clarke W, Torner J, Todd MM, IHAST Investigators. Effect of nitrous oxide use on long-term neurologic and neuropsychological outcome in patients who received temporary proximal artery occlusion during cerebral aneurysm clipping surgery. Anesthesiology. 2009 Mar;110(3):563–573.

Published In

Anesthesiology

DOI

EISSN

1528-1175

Publication Date

March 2009

Volume

110

Issue

3

Start / End Page

563 / 573

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surgical Instruments
  • Prospective Studies
  • Postoperative Complications
  • Nitrous Oxide
  • Neurosurgical Procedures
  • Neuropsychological Tests
  • Nervous System Diseases
  • Middle Aged
  • Male