A 74-year-old woman with a history of a previous total abdominal hysterectomy presents with abdominal pain and distention for 3 days. She is noted on plain films to have dilated small-bowel and air-fluid levels. She is taken to the operating room for a small-bowel obstruction. Which of the following inhalational anesthetics should be avoided because of accumulation in air-filled cavities during general anesthesia?
Diethyl ether
Nitrous oxide
Halothane
Methoxyflurane
Nitrous oxide has a low solubility compared with other inhalation anesthetics; nitrous oxide is more soluble in blood than nitrogen and is the only anesthetic gas less dense than air. As a result of these propeies, nitrous oxide may cause progressive distension of air-filled spaces during prolonged anesthesia. Since nitrous oxide diffuses into gas-filled compaments faster than nitrogen can diffuse out, its use can lead to worsened distention, which may be undesirable (eg, in an operation for intestinal obstruction).
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