Nitrous oxide (N2O) has a significant impact on neuromonitoring, comparable to that of volatile inhalation agents. When used in conjunction with volatile agents, the effects of N2O are synergistic, amplifying the overall impact on neuromonitoring signals. This synergy necessitates careful consideration by anesthesia providers to ensure accurate interpretation of monitoring data during surgery.
One of the primary effects of N2O on the electroencephalogram (EEG) is an increase in frequency. However, the exact effects can vary depending on the combination of other anesthetic agents being administered. In addition to its effects on EEG, N2O can influence other neuromonitoring modalities. For instance, it may alter somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs). The presence of N2O can affect the amplitude and latency of these evoked potentials, potentially masking or mimicking signs of neural compromise.
To mitigate the impact of N2O on neuromonitoring, anesthesia providers often employ strategies such as reducing the concentration of N2O or using alternative anesthetic agents (such as TIVA) that have a lesser effect on monitoring signals.
