Nitrous oxide and serious long-term morbidity and mortality in the evaluation of nitrous oxide in the gas mixture for anaesthesia (ENIGMA)-II trial

Kate Leslie, Paul S Myles, Jessica Eleonore Kasza, Andrew Benjamin Forbes, Philip Peyton, Matthew T V Chan, Michael Paech, Daniel Sessler, William Scott Beattie, Philip J Devereaux, Sophia Wallace

Research output: Contribution to journalArticleResearchpeer-review

Abstract

The Evaluation of Nitrous Oxide in the Gas Mixture for Anaesthesia (ENIGMA)-II trial randomly assigned 7,112 noncardiac surgery patients at risk of perioperative cardiovascular events to 70 N2O or 70 N2 groups. The aim of this follow-up study was to determine the effect of nitrous oxide on a composite primary outcome of death and major cardiovascular events at 1 yr after surgery. Methods: One-year follow-up was conducted via a medical record review and telephone interview. Disability was defined as a Katz index of independence in activities of daily living score less than 8. Adjusted odds ratios and hazard ratios were calculated as appropriate for primary and secondary outcomes. Results: Among 5,844 patients evaluated at 1 yr, 435 (7.4 ) had died, 206 (3.5 ) had disability, 514 (8.8 ) had a fatal or nonfatal myocardial infarction, and 111 (1.9 ) had a fatal or nonfatal stroke during the 1-yr follow-up period. Exposure to nitrous oxide did not increase the risk of the primary outcome (odds ratio, 1.08; 95 CI, 0.94 to 1.25; P = 0.27), disability or death (odds ratio, 1.07; 95 CI, 0.90 to 1.27; P = 0.44), death (hazard ratio, 1.17; 95 CI, 0.97 to 1.43; P = 0.10), myocardial infarction (odds ratio, 0.97; 95 CI, 0.81 to 1.17; P = 0.78), or stroke (odds ratio, 1.08; 95 CI, 0.74 to 1.58; P = 0.70). Conclusion: These results support the long-term safety of nitrous oxide administration in noncardiac surgical patients with known or suspected cardiovascular disease. ? 2015, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc.
Original languageEnglish
Pages (from-to)1267 - 1280
Number of pages14
JournalAnesthesiology
Volume123
Issue number6
DOIs
Publication statusPublished - 2015

Cite this

@article{e5bbefc6b15641e6b92d3d9a64c9cce0,
title = "Nitrous oxide and serious long-term morbidity and mortality in the evaluation of nitrous oxide in the gas mixture for anaesthesia (ENIGMA)-II trial",
abstract = "The Evaluation of Nitrous Oxide in the Gas Mixture for Anaesthesia (ENIGMA)-II trial randomly assigned 7,112 noncardiac surgery patients at risk of perioperative cardiovascular events to 70 N2O or 70 N2 groups. The aim of this follow-up study was to determine the effect of nitrous oxide on a composite primary outcome of death and major cardiovascular events at 1 yr after surgery. Methods: One-year follow-up was conducted via a medical record review and telephone interview. Disability was defined as a Katz index of independence in activities of daily living score less than 8. Adjusted odds ratios and hazard ratios were calculated as appropriate for primary and secondary outcomes. Results: Among 5,844 patients evaluated at 1 yr, 435 (7.4 ) had died, 206 (3.5 ) had disability, 514 (8.8 ) had a fatal or nonfatal myocardial infarction, and 111 (1.9 ) had a fatal or nonfatal stroke during the 1-yr follow-up period. Exposure to nitrous oxide did not increase the risk of the primary outcome (odds ratio, 1.08; 95 CI, 0.94 to 1.25; P = 0.27), disability or death (odds ratio, 1.07; 95 CI, 0.90 to 1.27; P = 0.44), death (hazard ratio, 1.17; 95 CI, 0.97 to 1.43; P = 0.10), myocardial infarction (odds ratio, 0.97; 95 CI, 0.81 to 1.17; P = 0.78), or stroke (odds ratio, 1.08; 95 CI, 0.74 to 1.58; P = 0.70). Conclusion: These results support the long-term safety of nitrous oxide administration in noncardiac surgical patients with known or suspected cardiovascular disease. ? 2015, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc.",
author = "Kate Leslie and Myles, {Paul S} and Kasza, {Jessica Eleonore} and Forbes, {Andrew Benjamin} and Philip Peyton and Chan, {Matthew T V} and Michael Paech and Daniel Sessler and Beattie, {William Scott} and Devereaux, {Philip J} and Sophia Wallace",
year = "2015",
doi = "10.1097/ALN.0000000000000908",
language = "English",
volume = "123",
pages = "1267 -- 1280",
journal = "Anesthesiology",
issn = "0003-3022",
publisher = "American Society of Anesthesiologists",
number = "6",

}

Nitrous oxide and serious long-term morbidity and mortality in the evaluation of nitrous oxide in the gas mixture for anaesthesia (ENIGMA)-II trial. / Leslie, Kate; Myles, Paul S; Kasza, Jessica Eleonore; Forbes, Andrew Benjamin; Peyton, Philip; Chan, Matthew T V; Paech, Michael; Sessler, Daniel; Beattie, William Scott; Devereaux, Philip J; Wallace, Sophia.

In: Anesthesiology, Vol. 123, No. 6, 2015, p. 1267 - 1280.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Nitrous oxide and serious long-term morbidity and mortality in the evaluation of nitrous oxide in the gas mixture for anaesthesia (ENIGMA)-II trial

AU - Leslie, Kate

AU - Myles, Paul S

AU - Kasza, Jessica Eleonore

AU - Forbes, Andrew Benjamin

AU - Peyton, Philip

AU - Chan, Matthew T V

AU - Paech, Michael

AU - Sessler, Daniel

AU - Beattie, William Scott

AU - Devereaux, Philip J

AU - Wallace, Sophia

PY - 2015

Y1 - 2015

N2 - The Evaluation of Nitrous Oxide in the Gas Mixture for Anaesthesia (ENIGMA)-II trial randomly assigned 7,112 noncardiac surgery patients at risk of perioperative cardiovascular events to 70 N2O or 70 N2 groups. The aim of this follow-up study was to determine the effect of nitrous oxide on a composite primary outcome of death and major cardiovascular events at 1 yr after surgery. Methods: One-year follow-up was conducted via a medical record review and telephone interview. Disability was defined as a Katz index of independence in activities of daily living score less than 8. Adjusted odds ratios and hazard ratios were calculated as appropriate for primary and secondary outcomes. Results: Among 5,844 patients evaluated at 1 yr, 435 (7.4 ) had died, 206 (3.5 ) had disability, 514 (8.8 ) had a fatal or nonfatal myocardial infarction, and 111 (1.9 ) had a fatal or nonfatal stroke during the 1-yr follow-up period. Exposure to nitrous oxide did not increase the risk of the primary outcome (odds ratio, 1.08; 95 CI, 0.94 to 1.25; P = 0.27), disability or death (odds ratio, 1.07; 95 CI, 0.90 to 1.27; P = 0.44), death (hazard ratio, 1.17; 95 CI, 0.97 to 1.43; P = 0.10), myocardial infarction (odds ratio, 0.97; 95 CI, 0.81 to 1.17; P = 0.78), or stroke (odds ratio, 1.08; 95 CI, 0.74 to 1.58; P = 0.70). Conclusion: These results support the long-term safety of nitrous oxide administration in noncardiac surgical patients with known or suspected cardiovascular disease. ? 2015, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc.

AB - The Evaluation of Nitrous Oxide in the Gas Mixture for Anaesthesia (ENIGMA)-II trial randomly assigned 7,112 noncardiac surgery patients at risk of perioperative cardiovascular events to 70 N2O or 70 N2 groups. The aim of this follow-up study was to determine the effect of nitrous oxide on a composite primary outcome of death and major cardiovascular events at 1 yr after surgery. Methods: One-year follow-up was conducted via a medical record review and telephone interview. Disability was defined as a Katz index of independence in activities of daily living score less than 8. Adjusted odds ratios and hazard ratios were calculated as appropriate for primary and secondary outcomes. Results: Among 5,844 patients evaluated at 1 yr, 435 (7.4 ) had died, 206 (3.5 ) had disability, 514 (8.8 ) had a fatal or nonfatal myocardial infarction, and 111 (1.9 ) had a fatal or nonfatal stroke during the 1-yr follow-up period. Exposure to nitrous oxide did not increase the risk of the primary outcome (odds ratio, 1.08; 95 CI, 0.94 to 1.25; P = 0.27), disability or death (odds ratio, 1.07; 95 CI, 0.90 to 1.27; P = 0.44), death (hazard ratio, 1.17; 95 CI, 0.97 to 1.43; P = 0.10), myocardial infarction (odds ratio, 0.97; 95 CI, 0.81 to 1.17; P = 0.78), or stroke (odds ratio, 1.08; 95 CI, 0.74 to 1.58; P = 0.70). Conclusion: These results support the long-term safety of nitrous oxide administration in noncardiac surgical patients with known or suspected cardiovascular disease. ? 2015, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc.

UR - http://anesthesiology.pubs.asahq.org/article.aspx?articleid=2466534

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DO - 10.1097/ALN.0000000000000908

M3 - Article

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SN - 0003-3022

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ER -