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N 2 O strongly prevents adhesion formation and postoperative pain in open surgery through a drug-like effect.

Background: Microsurgical tenets and peritoneal conditioning during laparoscopic surgery (LS) decrease postoperative adhesions and pain. For a trial in human, the strong beneficial effects of N2 O needed to be confirmed in open surgery (OS).

Results: In a mouse model for OS, the effect of the gas environment upon adhesions was evaluated. Experiment I evaluated desiccation and the duration of exposure to CO2 , N2 O or CO2  + 4%O2 . Experiment II evaluated the dose-response curve of adding N2 O to CO2 . Experiment III compared humidified CO2  + 10% N2 O during LS and OS.In OS, 30- and 60-min exposure to non-humidified CO2 caused mortality of 33 and 100%, respectively. Mortality was prevented by humidification, by dry N2 O or dry CO2  + 4%O2 . Adhesions increased with the duration of exposure to CO2 ( p  < 0.0001) and decreased slightly by humidification or by the addition of 4% O2 . N2 O strongly decreased adhesions at concentrations of 5% or greater. With humidified CO2  + 10% N2 O, adhesion formation was similar in OS and LS.

Conclusions: The drug-like and strong beneficial effect of low concentrations of N2 O is confirmed in OS.

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