Effects of Low-Concentration Nitrous Oxide Anesthesia on Patient Anxiety During Cataract Surgery: A Retrospective Cohort Study

Hirofumi Sasajima, Masahiro Zako, Yoshiki Ueta, Kenta Murotani, Hirofumi Sasajima, Masahiro Zako, Yoshiki Ueta, Kenta Murotani

Abstract

Purpose: We investigated the effects of 30% low-concentration nitrous oxide (N2O) anesthesia on anxiety, pain, and vital signs and the patient population that would benefit from low-concentration N2O anesthesia during cataract surgery.

Patients and methods: Sixty-three patients who underwent cataract surgery due to visual impairment from cataracts were included in this single-center retrospective cohort study conducted at the Ophthalmology Department of Shinseikai Toyama Hospital, Japan. Fifty eyes of 39 patients received a combination of local and N2O anesthesia (N2O group), and 30 eyes of 24 patients received local anesthesia without N2O anesthesia (Air group). The primary outcome measures were visual analogue scale (VAS) scores for patient anxiety, pain, and vital signs. The secondary outcome measures were the patient population.

Results: The change in the VAS scores for anxiety and pain decreased significantly (p = 0.002 and p = 0.014, respectively) in the N2O group (-15.6 ± 22.9 and 12.4 ± 14.9, respectively) compared with that in the Air group (1.2 ± 20.6 and 24.2 ± 22.4, respectively). The systolic and diastolic blood pressure changes did not significantly differ between both groups (p = 0.093 and p = 0.23, respectively). The change in heart rate decreased significantly (p = 0.001) in the N2O group (-4.8 ± 4.8 bpm) compared with that in the Air group (-0.6 ± 5.8 bpm). Multivariate analyses demonstrated that the change in anxiety level in the N2O group correlated significantly with patient age (p = 0.045) and preoperative VAS score for anxiety (p = 0.0001), whereas the change in anxiety level in the Air group did not correlate with any factor.

Conclusion: Low-concentration N2O anesthesia showed beneficial effects on intraoperative anxiety and pain during cataract surgery; this may aid the stabilization of intraoperative vital signs. Moreover, low-concentration N2O anesthesia during cataract surgery could benefit young patients and patients with high levels of preoperative anxiety.

Keywords: cataract surgery; low-concentration nitrous oxide anesthesia; patient anxiety.

Conflict of interest statement

The authors have no conflicts of interest to declare.

© 2022 Sasajima et al.

Figures

Figure 1
Figure 1
Comparison of intraoperative anxiety (A), change in anxiety level (B), intraoperative pain (C), and intraoperative nausea (D) between the nitrous oxide (N2O) anesthesia group and the Air group. The change in anxiety level was calculated as the intraoperative visual analogue scale (VAS) score for anxiety minus the preoperative VAS score for anxiety (B). *p<0.05. **p<0.01.
Figure 2
Figure 2
Comparison of intraoperative systolic blood pressure (SBP) (A), change in SBP (B), intraoperative diastolic blood pressure (DBP) (C), and change in DBP (D) between the nitrous oxide (N2O) anesthesia group and the Air group. The changes in SBP and DBP were calculated as the mean intraoperative SBP and DBP values minus the preoperative SBP and DBP values, respectively (B and D). * p<0.05.
Figure 3
Figure 3
Comparison of intraoperative heart rate (HR) (A), change in HR (B), intraoperative oxygen saturation (SpO2) (C), and change in the SpO2 (D) between the nitrous oxide (N2O) anesthesia group and the Air group. The changes in HR and SpO2 were calculated as the mean intraoperative HR and SpO2 values minus the preoperative HR and SpO2 values, respectively (B and D). *p<0.05. **p<0.01.

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