Abstract
BackgroundMegaloblastic anemia or bone marrow changes could occur after prolonged nitrous oxide inhalation via vitamin B12 inactivation related DNA synthesis impairment. Previous researches have studied hematological changes with nitrous oxide exposure, but only in adults or adolescents. Pre-school age children with active hematopoietic red bone marrow are more vulnerable to potential side effects of nitrous oxide and might experience growth impairment. The purpose of our study was to analyze red blood cell morphology changes under nitrous oxide anesthesia in pre-school age children.MethodsOne hundred thirty-six children under 5 years old scheduled for hemivertebra resection were analyzed. According to fresh gas type in anesthesia records, 71 children who received nitrous oxide in oxygen during anesthesia maintenance were categorized into the nitrous oxide group and the other 65 who received air in oxygen were the air group. Complete blood counts in perioperative period were assessed for anemia, macrocytosis, microcytosis, anisocytosis, hyperchromatosis and hypochromatosis. The peak value and change percentage were calculated for mean corpuscular volume and red cell distribution width.ResultsForty-two children in the air group (64.6%) and 30 in the nitrous oxide group (42.3%) developed anemia (P = 0.009). None developed macrocytosis in both groups. Postoperative mean corpuscular volume peaked (mean [95% confidence interval]) at 83.7(82.9–84.4) fL, and 83.2(82.4–83.9) fL and postoperative red cell distribution width at 13.8% (13.4–14.2%), and 13.9% (13.6–14.2%) for the air group and the nitrous oxide group. Both the relative change of mean corpuscular volume (P = 0.810) and red cell distribution width (P = 0.456) were similar between the two groups.ConclusionsNo megaloblastic red blood cell changes were observed with nitrous oxide exposure for 4 h in pre-school age children undergoing hemivertebra resection.
Highlights
Megaloblastic anemia or bone marrow changes could occur after prolonged nitrous oxide inhalation via vitamin B12 inactivation related deoxyribonucleic acid (DNA) synthesis impairment
Bone cavities in pre-school age children are filled with active hematopoietic red bone marrow that is vulnerable to vitamin B12 and other nutrients deficiency
Considering young children might be more vulnerable to Nitrous oxide (N2O) exposure, a retrospective cohort study on patients under 5 years old scheduled for hemivertebra resection was applied to analyze changes in red blood cell morphology under N2O anesthesia
Summary
Megaloblastic anemia or bone marrow changes could occur after prolonged nitrous oxide inhalation via vitamin B12 inactivation related DNA synthesis impairment. Pre-school age children with active hematopoietic red bone marrow are more vulnerable to potential side effects of nitrous oxide and might experience growth impairment. The purpose of our study was to analyze red blood cell morphology changes under nitrous oxide anesthesia in pre-school age children. Bone cavities in pre-school age children are filled with active hematopoietic red bone marrow that is vulnerable to vitamin B12 and other nutrients deficiency. Since the side effects of N2O are dose-dependent, children undergoing prolonged major surgery are more likely to develop macrocytosis and megaloblastic anemia, which might be accompanied by slower recovery and a longer hospital stay. Considering young children might be more vulnerable to N2O exposure, a retrospective cohort study on patients under 5 years old scheduled for hemivertebra resection was applied to analyze changes in red blood cell morphology under N2O anesthesia
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