Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
Curr Opin Anaesthesiol. 2010 Oct;23(5):544-50. doi: 10.1097/ACO.0b013e32833e1520.
To address controversial issues surrounding the use of nitrous oxide as a component of anesthesia in neurosurgical and neurologically at-risk patients.
Nitrous oxide has been used as a component of general anesthesia for over 160 years and has contributed to countless apparently uneventful anesthetics in neurologically at-risk patients. Avoidance of nitrous oxide in specific circumstances, such as pre-existing pneumocephalus, during acute venous air embolism, and in patients with disorders of folate metabolism, is warranted. However, various controversies exist regarding the use of this drug in the general neurosurgical population. Specifically, some suggest a possible association between nitrous oxide and the postoperative development of tension pneumocephalus despite lack of data to support this notion. Additionally, data describing alterations of cerebral hemodynamics and metabolism and exacerbation of ischemic neurologic injury by nitrous oxide are inconsistent. Recent data derived from humans having cerebral aneurysm clipping failed to show any long-term adverse effect from the use of nitrous oxide on gross neurologic or cognitive function.
Except in a few specific circumstances, there exists no conclusive evidence to support the dogmatic avoidance of nitrous oxide in neurosurgical patients.
解决在神经外科和神经功能受损患者的麻醉中使用一氧化二氮（笑气）作为成分的相关争议问题。
一氧化二氮作为全身麻醉的一种成分已经使用了 160 多年，并且为无数神经功能受损患者的看似无事故的麻醉做出了贡献。在某些特定情况下，如存在先前的气胸、急性静脉空气栓塞期间，以及在叶酸代谢紊乱的患者中，避免使用一氧化二氮是合理的。然而，在一般神经外科人群中使用这种药物存在各种争议。具体来说，尽管缺乏数据支持这一观点，但有些人认为一氧化二氮与术后张力性气胸的发展之间可能存在关联。此外，描述一氧化二氮对脑血流动力学和代谢的改变以及加重缺血性神经损伤的数据并不一致。最近源自接受脑动脉瘤夹闭术的人类的数据并未显示出在神经外科患者中使用一氧化二氮对大体神经或认知功能有任何长期不良影响。
除非在少数特定情况下，否则没有确凿的证据支持在神经外科患者中盲目避免使用一氧化二氮。
