Pulmonary and systemic hemodynamic effects of nitrous oxide in infants with normal and elevated pulmonary vascular resistance.

The hemodynamic response to 50% nitrous oxide was studied in 12 sedated but responsive infants in the intensive care unit following repair of their congenital heart disease. One-half of the infants studied had an elevated pulmonary vascular resistance index (PVRI greater than 3.5 Wood units). During mechanical ventilation with a fractional inspired O2 concentration (FIO2) of 0.5, hemodynamic parameters were measured after equilibration with 50% nitrogen and then after 50% nitrous oxide. The sequence was repeated once to assure reproducibility of the responses. Average heart rate decreased by 9%, mean arterial blood pressure decreased by 12%, and cardiac index decreased by 13% in both the elevated and normal PVRI groups each time nitrous oxide was given. Although statistically significant, these changes would not generally be clinically important except in infants with severely compromised cardiovascular reserve. In contrast, pulmonary artery pressure and PVRI were not significantly changed by administration of 50% nitrous oxide in either the group with normal PVRI or the group with preexisting elevated PVRI. We conclude that while these mild depressant effects of nitrous oxide on systemic hemodynamics in infants are similar to those previously reported in adults, in infants nitrous oxide does not produce the elevations in pulmonary artery pressure and pulmonary vascular resistance seen in adults.