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The "second gas effect" is not a valid concept

Sun X-G1, F Su, Y Q Shi

  • 1Department of Anesthesiology, Harbor-University of California Los Angeles Medical Center, Torrance 90509-2910, USA.

Anesthesia and Analgesia
|January 23, 1999
PubMed
Summary
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The "second gas effect" is not valid in clinical practice. Nitrous oxide (N2O) did not enhance enflurane uptake or alveolar concentration during controlled ventilation, indicating the effect is nonexistent.

Area of Science:

  • Anesthesiology
  • Pharmacokinetics

Background:

  • The
  • second gas effect
  • is a theoretical phenomenon where a high concentration of one gas can accelerate the uptake of a second, lower concentration gas.
  • Its clinical validity remains debated, particularly under controlled ventilation conditions.

Purpose of the Study:

  • To investigate the validity of the
  • second gas effect
  • by examining the pharmacokinetics of enflurane when administered with or without nitrous oxide (N2O).

Main Methods:

  • Pharmacokinetic analysis of 0.2% enflurane in 14 healthy male patients under controlled constant volume ventilation.
  • Measurement of alveolar (end-tidal) and inspired concentrations (FA/FI ratio) and arterial blood concentrations of enflurane.

Related Experiment Videos

  • Comparison between a group receiving enflurane with 80% N2O and a control group receiving enflurane alone.

    • Main Results:

    • No significant difference in the FA/FI ratio of enflurane was observed between the N2O and control groups at any time point.
    • Arterial blood concentrations of enflurane increased progressively but were not significantly different between the two groups.
    • High concentrations of N2O did not facilitate the increase of FA or enhance the uptake of enflurane.

    Conclusions:

    • The
    • second gas effect
    • is not a valid concept in clinical practice under controlled ventilation.
    • The concentrating and augmentation effects attributed to the second gas effect are negligible in this setting.