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To the Editor.—
The article entitled "Nitrous Oxide as an Analgesic in Acute Myocardial Infarction" (235: 924, 1976) raises some serious questions regarding the manner and safety of nitrous oxide administration in acute myocardial infarction.We have recently reported a myocardial depressant effect of nitrous oxide 40% in nine patients with documented coronary artery disease during cardiac catheterization (Anesthesiology 44:16, 1976) compared with four patients having angina but no evidence of coronary disease by angiography. In the former group, myocardial contractility as measured by the left ventricular derivative of pressure/derivative of time (LVdpdt) at constant isometric pressure was depressed an average of 14%, left ventricular end-diastolic pressure (LVEDP) was elevated 2 mm Hg (average, 21%), while heart rate and cardiac output were not significantly changed. The four patients catheterized for angina without angiographic findings of coronary artery disease showed cardiovascular responses similar to young volunteers inhaling nitrous oxide 40%
Eisele JH, Reitan JA, Miller RR. Nitrous Oxide in Myocardial Infarction. JAMA. 1976;236(18):2050–2051. doi:10.1001/jama.1976.03270190012005
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