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Background: 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.
CME Credit: 1.00 AMA PRA Category 1 Credit™
Required Hardware / Software:Adobe Acrobat Reader, Internet connection. Web browser version must have been released within the last three years.
Activity Release Date:11/17/2015
Activity Expiration Date:11/16/2018
Learning Objectives:After successfully completing this activity, the learner will be able to do the following:
Faculty & Credentials:
Editor-in-Chief: James C. Eisenach, M.D., receives consulting fees from Aerial BioPharma LLC and Cubist Pharmaceuticals, Inc.
CME Editors: Leslie C. Jameson, M.D., receives honoraria from GE Medical International and Masimo Corporation. Dan J. Kopacz, M.D., has an equity position in SoloDex, LLC.
Authors: Kate Leslie, M.B.B.S., M.D., M.Epid., M.Hlth.Serv. Mt., F.A.N.Z.C.A., Paul S. Myles, M.B.B.S., M.D., M.P.H., F.A.N.Z.C.A., F.R.C.A., Jessica Kasza, B.Sc.(Hons.), Ph.D., Andrew Forbes, B.Sc.(Hons.), M.Sc., Ph.D., Philip J. Peyton, M.B.B.S., M.D., Ph.D., F.A.N.Z.C.A., Matthew T. V. Chan,M.B.B.S., F.A.N.Z.C.A., F.H.K.C.A., F.H.K.A.M., Michael J. Paech, M.B.B.S., D.M., D.R.C.O.G., F.R.C.A., F.A.N.Z.C.A., F.F.P.M.A.N.Z.C.A., F.R.A.N.Z.C.O.G. (Hon.), Daniel I. Sessler, M.D., W. Scott Beattie, M.D., Ph.D., F.R.C.P.C., P. J. Devereaux, M.D., Ph.D., F.R.C.P.C., and Sophie Wallace, M.P.H., have reported no financial relationships with commercial interests.
Author: Lee A. Fleisher, M.D., has reported no financial relationships with commercial interests.
ASA Staff: Kari L. Lee, Editorial Manager, has reported no financial relationships with commercial interests. Ginger Yarger, Editor, has an equity position in Merck & Co.
Disclosure StatementThe American Society of Anesthesiologists remains strongly committed to providing the best available evidence-based clinical information to participants of this educational activity and requires an open disclosure of any potential conflict of interest identified by our faculty members. It is not the intent of the American Society of Anesthesiologists to eliminate all situations of potential conflict of interest, but rather to enable those who are working with the American Society of Anesthesiologists to recognize situations that may be subject to question by others. All disclosed conflicts of interest are reviewed by the educational activity course director/chair to ensure that such situations are properly evaluated and, if necessary, resolved. The American Society of Anesthesiologists educational standards pertaining to conflict of interest are intended to maintain the professional autonomy of the clinical experts inherent in promoting a balanced presentation of science. Through our review process, all American Society of Anesthesiologists CME activities are ensured of independent, objective, scientifically balanced presentations of information. Disclosure of any or no relationships will be made available for all educational activities.
The information provided at this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.
Core Competencies:Medical knowledge
Target Audience:ANESTHESIOLOGY Journal CME is intended for anesthesiologists. Researchers and other health care professionals with an interest in anesthesiology may also participate.
CME Credit: 1.00 AMA PRA Category 1 Credit™
The American Society of Anesthesiologists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The American Society of Anesthesiologists designates this journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
1.00 Non-physician Credit Non-physicians may receive a Certificate of Completion stating that this activity was designated for 1.00 AMA PRA Category 1 Credit(s)™.
Activity Release Date: 11/17/2015 (All day) Activity Expiration Date: 11/16/2018 (All day)
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