Article Notes
Article pearls, summaries and comments.
- Myles et al. ENIGMA-II trial (Lancet 2014): The safety of addition of nitrous oxide to general anaesthesia in at-risk patients having major non-cardiac surgery (ENIGMA-II)
- Møller et al. (BJA 2014): Does anaesthesia with nitrous oxide affect mortality or cardiovascular morbidity?
Despite the statistical significance of this finding, I question the clinical significance and appropriateness – especially in the context of ongoing questions regarding the safety of HES solutions and given there are alternative interventions also shown to reduce symptomatic hypotension in this setting.
Related confirming the safety of nitrous oxide:
This analysis is not practice-changing, but instead highlights our continued lack of understanding of the outcome benefit (or not) of neuraxial versus general anaesthesia in high risk patient groups.
Interestingly, it is also a meta-analysis of meta-analyses, demonstrating that there are limits to the answers that re-analysing existing data may provide.