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10. The prevalence, risks, and detection of driving under the influence of nitrous oxide.

Author

Vinckenbosch, Frederick R. J., Jiménez, Dinesh Durán, Helmerhorst, Hendrik, Dahan, Albert, Aarts, Leon, Bikker, Floris, Theunissen, Eef, and Ramaekers, Johannes G.

Abstract

Nitrous oxide (N2O), colloquially known as laughing gas, is a common recreational drug of abuse. The gas is inhaled in its undiluted form from a party balloon. Its intoxicating effects are described as dissociative and euphoric, accompanied by ataxia, hypoxia, and attenuated consciousness. Therefore, the recreational use of N2O appears irreconcilable with operating a vehicle in road traffic. However, the Netherlands, one of the leading countries regarding prevalence of recreational N2O use, has seen a sharp increase in police reports of N2O-related traffic incidents since 2016. Road traffic deaths associated with recreational N2O use have also been reported in the United Kingdom, as well as a recent increase in traffic incidents. Hence, driving under the influence of nitrous oxide (DUINO) is possibly an underreported threat to road traffic safety. Based on the limited information available at this time, the current review considers the prevalence of DUINO, its effects driving performance, and approaches to road-side detection. It is concluded that DUINO is a potentially significant threat to road traffic safety. Although its prevalence is unclear, it is almost certain that DUINO is accompanied by severe driving impairment, based on its pharmacodynamics and documented cognitive and psychomotor effects in medical studies. The pharmacokinetic profile of N2O lends credibility to the notion that recent use can be demonstrated in breath, blood, and saliva. However, the analytical complexities of such measurements warrant elaborate research into N2O detection techniques. [ABSTRACT FROM AUTHOR]

Published
2024
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29. Variation in anesthesia practices in abdominal surgery

Author

Stens, J, Hering, J.P., Veelo, Denise P., Frank, Michael, van Dorp, Eveline, Godfried, MB, de Wit, Frank, Wolthuis, E.K., van de Ven, PM, Aarts, Leon P.H.J., Boer, C, Geerts, B.F., Scheeren, T.W.L., Anesthesiology, ICaR - Circulation and metabolism, Epidemiology and Data Science, ACS - Microcirculation, and ACS - Diabetes & metabolism

Published
2021

33. Driving Pressure During General Anesthesia for Open Abdominal Surgery (DESIGNATION): study protocol of a randomized clinical trial

Author

Hol, Liselotte, Nijbroek, Sunny G. L. H., Neto, Ary Serpa, de Abreu, Marcelo Gama, Pelosi, Paolo, Hemmes, Sabrine N. T., Aarts, Leon P. H. J., Akkerman, Ronald D. L., Albersen, Juliette J. E., Aurilio, Caterina, Battaglini, Denise, de Boer, Hans D., Boom, Annemieke, Boer, Christa, Brouwer, Tammo, Buhre, Wolfgang F. F. A., Bulte, Carolina S. E., Edward-Rutten, Gitara M., Godfried, Marc B., Helmerhorst, Hendrik J. F., Hofland, Jan, Hoogenboom, Hester, Ten Hoope, W., Houweling, Bernard M., Huhn, Ragnar, Konijn, Wanda, Koopman-van Gemert, Ankie W. M. M., De Korte-de Boer, Dianne J., Kortekaas, Minke C., Van Lier, Felix, Preckel, Benedikt, Rad, Mandana, Sansone, Pasquale, Stamkot, Andre, Stolker, Robert Jan, Thiel, Bram, Ubben, Johannes F. H., Struys, Michel, In 't Veld, Bastiaan A., Wrigge, Hermann, Zeillemaker-Hoekstra, Miriam, van der Zwan, Tim, Zwijsen, Johannes H. M. J., Hollmann, Markus W., Schultz, Marcus J., Anesthesiology, ACS - Diabetes & metabolism, Hol, L, Nijbroek, Sglh, Neto, A, de Abreu, Mg, Pelosi, P, Hemmes, Snt, Aarts, Lphj, Akkerman, Rdl, Albersen, Jje, Aurilio, C, Battaglini, D, de Boer, Hd, Boom, A, Boer, C, Brouwer, T, Buhre, Wffa, Bulte, Cse, Edward-Rutten, Gm, Godfried, Mb, Helmerhorst, Hjf, Hofland, J, Hoogenboom, H, Ten Hoope, W, Houweling, Bm, Huhn, R, Konijn, W, Koopman-van Gemert, Awmm, De Korte-de Boer, Dj, Kortekaas, Mc, van Lier, F, Preckel, B, Rad, M, Sansone, P, Stamkot, A, Stolker, Rj, Thiel, B, Ubben, Jfh, Struys, Mmrf, 't Veld, Bai, Wrigge, H, Zeillemaker-Hoekstra, M, van der Zwan, T, Zwijsen, Jhmj, Hollmann, Mw, Schultz, Mj, MUMC+: Centrum voor Acute en Kritieke Zorg (3), Anesthesiologie, MUMC+: MA Anesthesiologie (9), RS: MHeNs - R3 - Neuroscience, Graduate School, Intensive Care Medicine, APH - Quality of Care, ACS - Heart failure & arrhythmias, ACS - Pulmonary hypertension & thrombosis, ACS - Microcirculation, Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), Radiotherapy, Intensive Care, and Cardiology

Subjects
Lung Diseases, Male, ATELECTASIS, medicine.medical_treatment, Medicine (miscellaneous), Atelectasis, Intraoperative ventilation, law.invention, Positive-Pressure Respiration, DEFINITIONS, Study Protocol, 0302 clinical medicine, Mechanical ventilation, Randomized controlled trial, 030202 anesthesiology, law, OBESE-PATIENTS, Clinical endpoint, Medicine and Health Sciences, Medicine, Pharmacology (medical), END-EXPIRATORY-PRESSURE, 030212 general & internal medicine, Tidal volume, Postoperative pulmonary, Randomized Controlled Trials as Topic, Aged, 80 and over, lcsh:R5-920, Postoperative pulmonary complications, Delta P, Positive end-expiratory pressure, Abdominal Cavity, Pulmonary, Middle Aged, respiratory system, Treatment Outcome, Recruitment maneuver, Anesthesia, Surgical Procedures, Operative, Breathing, Female, lcsh:Medicine (General), therapeutics, Compliance, circulatory and respiratory physiology, Adult, Pulmonary complication, ΔP, complications, Anesthesia, General, 03 medical and health sciences, Young Adult, Postoperative complications, Double-Blind Method, Tidal Volume, Humans, LOW-TIDAL-VOLUME, Aged, POSTOPERATIVE PULMONARY COMPLICATIONS, business.industry, CHEST-WALL MECHANICS, medicine.disease, PREVENTION, Postoperative complication, PROTECTIVE MECHANICAL VENTILATION, respiratory tract diseases, Pulmonary complications, business, Postoperative pulmonary complication, LUNG, Abdominal surgery
Abstract

BackgroundIntraoperative driving pressure (ΔP) is associated with development of postoperative pulmonary complications (PPC). When tidal volume (VT) is kept constant, ΔP may change according to positive end-expiratory pressure (PEEP)-induced changes in lung aeration. ΔP may decrease if PEEP leads to a recruitment of collapsed lung tissue but will increase if PEEP mainly causes pulmonary overdistension. This study tests the hypothesis that individualized high PEEP, when compared to fixed low PEEP, protects against PPC in patients undergoing open abdominal surgery.MethodsThe “Driving prESsure durIng GeNeral AnesThesIa for Open abdomiNal surgery trial” (DESIGNATION) is an international, multicenter, two-group, double-blind randomized clinical superiority trial. A total of 1468 patients will be randomly assigned to one of the two intraoperative ventilation strategies. Investigators screen patients aged ≥ 18 years and with a body mass index ≤ 40 kg/m2, scheduled for open abdominal surgery and at risk for PPC. Patients either receive an intraoperative ventilation strategy with individualized high PEEP with recruitment maneuvers (RM) (“individualized high PEEP”) or one in which PEEP of 5 cm H2O without RM is used (“low PEEP”). In the “individualized high PEEP” group, PEEP is set at the level at which ΔP is lowest. In both groups of the trial, VTis kept at 8 mL/kg predicted body weight. The primary endpoint is the occurrence of PPC, recorded as a collapsed composite of adverse pulmonary events.DiscussionDESIGNATION will be the first randomized clinical trial that is adequately powered to compare the effects of individualized high PEEP with RM versus fixed low PEEP without RM on the occurrence of PPC after open abdominal surgery. The results of DESIGNATION will support anesthesiologists in their decisions regarding PEEP settings during open abdominal surgery.Trial registrationClinicaltrials.gov,NCT03884543. Registered on 21 March 2019.

Published
2020
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43. Opioid utility function: methods and implications

Author

van Dam, Cornelis Jan, primary, Algera, Marijke Hyke, additional, Olofsen, Erik, additional, Aarts, Leon, additional, Smith, Terry, additional, Velzen, Monique van, additional, Sarton, Elise, additional, Niesters, Marieke, additional, and Dahan, Albert, additional

Published
2020
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