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KMID : 0356019910060020123
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Koean Jounral of Critical Care Medicine
1991 Volume.6 No. 2 p.123 ~ p.129
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The Pancytopenia Associated with 50% Nitrous Oxide-Enflurane Anaesthesia
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Abstract
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Although nitrous oxide has been used as a mainstay of general anesthetic practice for more than a century, over the past 35 years we have become increasingly aware of its toxic proper- ties. In 1956, Lassen et al attributed the bone marrow depression and granulocytopenia to pro- longed exposure to nitrous oxide in tetanus patients. In 1982, Amos et reported nitrous oxide can cause megaloblastic bone marrow damage as little as one hour of exposure in seriously ill pateients.
Nitrous oxide inactivate the vitamin R 12 moiety of the enzyme methionine synthase. This inactivation disrupts biosynthetic pathways active in folate metabolism, impact DNA synthesis, and can induce bone marrow depression like that associated vitamin B 12 deficiency.
We present a case of pancytopenia which occured on 6th day after anesthesia with nitrous oxide and enflurane in 75 year old female patient. She had a radical subtotal gastrectomy be- cause of gastric cancer and exposured to 50% nitrous oxide for three and half hours. Pancyto- penia was corrected proagressively from 14 days after operation with intensive care including parenteral hyperalimentation and cyanocobalamin administration.
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