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Nitrous oxide can cause hematologic abnormalities, including death, if it is administered for several days. However, the adverse hematologic effects of its use for surgical anesthesia are unclear. Accordingly, we have studied the hematologic responses of patients undergoing procedures involving hematologic stress or prolonged anesthesia with and without nitrous oxide. We measured red cell count, hemoglobin concentration, mean red cell volume, reticulocyte count, platelet count, mean platelet volume, blood leukocyte level, and leukocyte differential in patients undergoing total hip arthroplasty or removal of an acoustic neuroma. Nitrous oxide did not affect the production of red blood cells or platelets. Nitrous oxide treatment was associated with an increase in postoperative leukocyte levels that was modestly but significantly smaller than that found in patients not given nitrous oxide. There was no evidence that this small decrease in maximal leukocytosis adversely affected clinical outcome.

It has been proposed that equilibration of nitrous oxide with blood plasma increases osmotic pressure and thereby causes hemodilution. However, calculations show that the 250-torr osmotic gradient produced by 0.7 atmosphere of nitrous oxide dissolved in blood plasma (separated from the other body fluids by a membrane permeable only to water) would be eliminated by a water shift which would dilute the plasma by only 4 percent. Permeability of the membrane to nitrous oxide would further reduce the shift. In vivo measurements confirmed the smallness of any osmotically induced shifts by demonstrating no significant transient changes in hematocrit value when 0.7 atmosphere of nitrous oxide was added to or removed from an inhaled anesthetic mixture in man. These results cast doubt on the suggestions that gas-induced osmosis is an important factor in dysbarism or in clinical anesthesia.