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Nitrous oxide in gas-filled eyes can have ‘disastrous’ results

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SAN FRANCISCO — The use of nitrous oxide during general anesthesia in eyes with previous long-acting gas tamponade can be “disastrous,” warn the authors of a retrospective study.

Gas expansion and elevated intraocular pressure can result from nitrous oxide administered with general anesthesia in subsequent surgery before a patient’s intraocular gas bubble has resorbed, the study authors suggest, with “potentially catastrophic results.”

H. Richard McDonald, MD, and colleagues at centers around the country identified five eyes of five patients who underwent general anesthesia using nitrous oxide. All eyes had significant pre-existing intraocular gas bubbles ranging from 40% to 90%, and the surgical procedures lasted from 1 to 4 hours. Follow-up ranged from 2 months to 9 years.

Four of the five eyes had final vision of 20/200 or worse and significant optic atrophy at the time of the last follow-up. Three eyes had no light perception.

The study is published in Retina.