Journal of Anesthesia

, Volume 29, Issue 3, pp 421–425 | Cite as

Concomitant administration of nitrous oxide and remifentanil reduces oral tissue blood flow without decreasing blood pressure during sevoflurane anesthesia in rabbits

  • Masataka Kasahara
  • Tatsuya Ichinohe
  • Sota Okamoto
  • Reina Okada
  • Hiroaki Kanbe
  • Nobuyuki Matsuura
Original Article



To determine whether continuous administration of nitrous oxide and remifentanil—either alone or together—alters blood flow in oral tissues during sevoflurane anesthesia.


Eight male tracheotomized Japanese white rabbits were anesthetized with sevoflurane under mechanical ventilation. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), common carotid arterial blood flow (CCBF), tongue mucosal blood flow (TMBF), mandibular bone marrow blood flow (BBF), masseter muscle blood flow (MBF), upper alveolar tissue blood flow (UBF), and lower alveolar tissue blood flow (LBF) were recorded in the absence of all test agents and after administration of the test agents (50 % nitrous oxide, 0.4 μg/kg/min remifentanil, and their combination) for 20 min.


Nitrous oxide increased SBP, DBP, MAP, CCBF, BBF, MBF, UBF, and LBF relative to baseline values but did not affect HR or TMBF. Remifentanil decreased all hemodynamic variables except DBP. Combined administration of nitrous oxide and remifentanil recovered SBP, DBP, MAP, and CCBF to baseline levels, but HR and oral tissue blood flow remained lower than control values.


Our findings suggest that concomitant administration of nitrous oxide and remifentanil reduces blood flow in oral tissues without decreasing blood pressure during sevoflurane anesthesia in rabbits.


Oral tissue blood flow Nitrous oxide Remifentanil Sevoflurane 


  1. 1.
    Kaneko Y. Experimental studies on vascular changes in fracture and osteomyelitis. Part I: vascular changes in mandibular fracture and healing. Bull Tokyo Dent Coll. 1968;9:123–46.Google Scholar
  2. 2.
    Fukunaga AF, Flacke WE, Bloor BC. Hypotensive effects of adenosine and adenosine triphosphate compared with sodium nitroprusside. Anesth Analg. 1982;61:273–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Bloor BC, Fukunaga AF, Ma C, Flacke WE, Ritter J, Etten AV, Olewine S. Myocardial hemodynamics during induced hypotension: a comparison between sodium nitroprusside and adenosine triphosphate. Anesthesiology. 1985;63:517–25.PubMedCrossRefGoogle Scholar
  4. 4.
    Rodrigo C. Induced hypotension during anesthesia, with special reference to orthognathic surgery. Anesth Prog. 1995;42:41–58.PubMedCentralPubMedGoogle Scholar
  5. 5.
    Davies DW, Greiss L, Kadar D, Steward DJ. Sodium nitroprusside in children: observations on metabolism during normal and abnormal responses. Canad Anaesth Soc J. 1975;22:553–60.PubMedCrossRefGoogle Scholar
  6. 6.
    Pasch T, Huk W. Cerebral complications following induced hypotension. Eur J Anaesthesiol. 1986;3:299–312.PubMedGoogle Scholar
  7. 7.
    Kemmochi M, Ichinohe T, Kaneko Y. Remifentanil decreases mandibular bone marrow blood flow during propofol or sevoflurane anesthesia in rabbits. J Oral Maxillofacial Surg. 2009;67:1245–50.CrossRefGoogle Scholar
  8. 8.
    Koshika K, Ichinohe T, Kaneko Y. Dose-dependent remifentanil decreases oral tissue blood flow during sevoflurane and propofol anesthesia in rabbits. J Oral Maxillofacial Surg. 2011;69:2128–34.CrossRefGoogle Scholar
  9. 9.
    Terakawa Y, Ichinohe T, Kaneko Y. Rocuronium and vecuronium do not affect mandibular bone marrow and masseter mauscular blood flow in rabbits. J Oral Maxillofacial Surg. 2010;68:15–20.CrossRefGoogle Scholar
  10. 10.
    Eastwood DW. The pharmacology of nitrous oxide. Clin Anesth. 1964;10:21–35.PubMedGoogle Scholar
  11. 11.
    Ichinohe T, Homma Y, Kaneko Y. Mucosal blood flow during various intravenous and inhalational anesthetics in the rabbit. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;85:268–71.PubMedCrossRefGoogle Scholar
  12. 12.
    Nishizawa S, Ichinohe T, Kaneko Y. Tissue blood flow reductions induced by remifentanil in rabbits and the effect of naloxone and phentolamine on these changes. J Oral Maxillofacial Surg. 2012;70:797–802.CrossRefGoogle Scholar
  13. 13.
    Bakoshi S, Yoshimura M, Inoue M, Tachibana A, Igawa T, Tamura T, Sato N. MAC of sevoflurane in the Japanese White rabbit (in Japanese). Clin Rep. 1987;21:105–8.Google Scholar
  14. 14.
    Scheller MS, Saidman LJ, Partridge BL. MAC of sevoflurane in humans and the New Zealand White rabbit. Can J Anaesth. 1988;35:153–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Fukunaga AF, Epstein RM. Sympathetic excitation during nitrous oxide-halothane anesthesia in the cat. Anesthesiology. 1973;39:23–36.PubMedCrossRefGoogle Scholar
  16. 16.
    Ebert TJ, Kampine JP. Nitrous oxide augments sympathetic outflow: direct evidence from human peroneal nerve recordings. Anesth Analg. 1989;69:444–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Ebert TJ. Differential effects of nitrous oxide on baroreflex control of heart rate and peripheral sympathetic nerve activity in humans. Anesthesiology. 1990;72:16–22.PubMedCrossRefGoogle Scholar
  18. 18.
    Sellgren J, Ponten J, Wallin BG. Percutaneous recording of muscle nerve sympathetic activity during propofol, nitrous oxide, and isoflurane anesthesia in humans. Anesthesiology. 1990;73:20–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Fukuda K. Opioid. In: Miller RD, editor. Miller’s Anesthesia. 7th ed. Philadelphia: Churchill Livingstone; 2010. p. 784–7.Google Scholar
  20. 20.
    Elliott P, O’Hare R, Bill KM, Phillips AS, Gibson FM, Mirakhur RK. Severe cardiovascular depression with remifentanil. Anesth Analg. 2000;91:58–61.PubMedGoogle Scholar
  21. 21.
    Reid JE, Mirakhur RK. Bradycardia after administration of remifentanil. Br J Anaesth. 2000;84:422–3.PubMedCrossRefGoogle Scholar
  22. 22.
    Kurdi O, Deleuze A, Marret E, Bonnet F. Asystole during anaesthetic induction with remifentanil and sevoflurane. Br J Anaesth. 2001;87:943.PubMedGoogle Scholar
  23. 23.
    Gan TJ. Risk factors for postoperative nausea and vomiting. Anesth Analg. 2006;102:1884–98.PubMedCrossRefGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2014

Authors and Affiliations

  • Masataka Kasahara
    • 1
  • Tatsuya Ichinohe
    • 2
  • Sota Okamoto
    • 2
  • Reina Okada
    • 2
  • Hiroaki Kanbe
    • 2
  • Nobuyuki Matsuura
    • 2
  1. 1.Department of PharmacologyTokyo Dental CollegeTokyoJapan
  2. 2.Department of Dental AnesthesiologyTokyo Dental CollegeTokyoJapan

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