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Pre-operative vitamin B infusion and prevention of nitrous oxide-induced homocysteine increase.

ABSTRACT: Nitrous oxide inactivates vitamin B(12) with detrimental consequences for folate and methionine metabolism, detectable by an increase in total plasma homocysteine. We hypothesised that a pre-operative vitamin B(12) and folate infusion prevents nitrous oxide-induced homocysteine increase. Sixty-three healthy patients having elective surgery were randomly allocated to receive either B-vitamin plus nitrous oxide; placebo plus nitrous oxide or placebo plus air. Fifty-nine patients completed the study. After intravenous B-vitamin infusion, plasma vitamin B(12) and folate concentrations increased 35-fold and 12-fold, respectively, on the first postoperative measurement. Patients who received B-vitamins developed a similar increase (18%) in homocysteine after nitrous oxide (1.9 micromolxl(-1); 95% CI 0.2-3.6 micromolxl(-1)) as those who did not (22%; 2.7 micromolxl(-1); 95% CI 0.6-4.8 micromolxl(-1)). Patients not receiving nitrous oxide had no homocysteine change (0.5 micromolxl(-1); 95% CI -0.8-1.9 micromolxl(-1)), indicating that pre-operative intravenous B-vitamins may not prevent nitrous oxide-induced hyperhomocysteinaemia.

SUBMITTER: Rao LK

PROVIDER: S-EPMC3732777 | biostudies-literature | 2010 Jul

REPOSITORIES: biostudies-literature

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Pre-operative vitamin B infusion and prevention of nitrous oxide-induced homocysteine increase.

Rao L K LK Francis A M AM Wilcox U U Miller J P JP Nagele P P

Anaesthesia 20100506 7

<h4>Summary</h4>Nitrous oxide inactivates vitamin B(12) with detrimental consequences for folate and methionine metabolism, detectable by an increase in total plasma homocysteine. We hypothesised that a pre-operative vitamin B(12) and folate infusion prevents nitrous oxide-induced homocysteine increase. Sixty-three healthy patients having elective surgery were randomly allocated to receive either B-vitamin plus nitrous oxide; placebo plus nitrous oxide or placebo plus air. Fifty-nine patients co ...[more]

PMID: 20477781

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Project description:Background: Nitrous oxide (N2O), commonly known as laughing gas, is inhaled recreationally because it produces the feelings of euphoria and freedom from pain. The risk of neurological dysfunction secondary to N2O abuse and its clinical diagnosis are, however, not yet sufficiently recognized, especially in China. Here, we have summarized the key clinical characteristics of N2O-induced neurological disorders. Materials and Methods: We recruited 20 patients with N2O-induced neurological disorders and analyzed their clinical features, laboratory data, magnetic resonance imaging and electromyography. We also carried out a literature review and compared 99 previously reported patients with our case series to confirm our results. Subgroup analysis was performed to explore the difference in demographical and clinical characteristics of N2O abuse between Asian and non-Asian patients. Results: The most common initial symptoms of N2O-induced neurological disorders were weakness and/or paresthesia. Most patients presented with myelopathy and/or peripheral neuropathy. The most commonly involved segment of the spinal cord was the cervical spinal cord, extending over 4-6 vertebral levels, but more than half of the patients with myelopathy had no sensory change at the corresponding spinal level. Homocysteine was found to be the most sensitive and practical indicator for diagnosis. Subgroup analysis showed that the Asian patients (median: 22.0 years old, Q1-Q3:19.0-26.0 years old) with N2O abuse were younger than non-Asian patients [26.0 (22.3-31.0) years old, P = 2.8 × 10-4]. The incidence of myelopathy combined with peripheral neuropathy was significantly higher in Asian patients than in non-Asian patients, who had myelopathy or peripheral neuropathy (P = 2 × 10-5). Conclusions: Key clinical characteristics of N2O abuse are longitudinally extensive cervical myelopathy and peripheral neuropathy. Recognition of these traits in young people in the age group of 20-30 years will provide important guidance for accurate diagnosis of neurological disease associated with N2O abuse. The clinical manifestations differ in Asian patients and non-Asian patients.

Dataset Information

Pre-operative vitamin B infusion and prevention of nitrous oxide-induced homocysteine increase.

Publications

Pre-operative vitamin B infusion and prevention of nitrous oxide-induced homocysteine increase.

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