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• W4235223005 abstract "To the Editor: Hartung's retrospective analysis at first glance appears to add fuel to the fire in incriminating nitrous oxide (N2 O) as an emesis-inducing anesthetic [1]. But as Fisher points out in his editorial [2], whether N2 O is guilty as charged can only be determined using studies with anesthetic regimens differing only by it's [N2 O's] omission, and by no means are the 27 studies cited by Hartung uniform in this regard. In statistical analyses such as this, as in magic tricks, what you don't see is as important as what you do see. We challenged Hartung's contention that his bibliography is complete and found four recent articles in which N2 O did not have a statistically significant higher incidence of emesis [3-6]. We added three of these articles to those in Hartung's study (Table 1), and, suspicious that 100% oxygen might have an antiemetic effect, created a contingency table (Table 2). It demonstrates (P < 0.049) that the ability to detect a statistically significant difference in emesis when using N2 O depends on whether air or 100% oxygen is used in comparison with N2 O. Eight of 12 studies that substituted 100% oxygen for N2 O found significantly less emesis in the oxygen group. But only three of 12 studies substituting air for N2 O reached significance in finding less emesis in the air group. Thus, what appears to be an inconsequential variable at first-the substitution of air or 100% oxygen for N2 O-becomes a confounding factor. It might be as erroneous to conclude from these data that 100% oxygen is an antiemetic as it is to conclude that N2 O causes emesis. We excluded two studies from this analysis [6,7] that involved total intravenous anesthesia with propofol because propofol is a widely accepted antiemetic. We also excluded studies involving N2 O as an analgesic since we object to comparing general anesthesia with awake analgesia, in accordance with the Fisher criterion mentioned above. Although Hartung graciously acknowledges several limitations of his methodology, the impressive P value (P < 0.00005) in the abstract for the higher incidence of vomiting with N (2) O is misleading.Table 1: Statistical Significance Versus Use of Air or OxygenTable 2: Contingency TableFrank J. Overdyk, MSEE, MD Raymond C. Roy, PhD, MD Department of Anesthesia and Perioperative Medicine; Medical University of South Carolina; Charleston, SC 29425-2207" @default.
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• W4235223005 date "1997-01-01" @default.
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• W4235223005 title "If Nitrous Oxide Induces Emesis, Maybe 100% Oxygen Is an Antiemetic" @default.
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• W4235223005 doi "https://doi.org/10.1213/00000539-199701000-00055" @default.
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