Transcutaneous Cranial Electrical Stimulation Increases the Potency of Nitrous Oxide in Humans

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Abstract
The potency, amnesic and postanesthetic analgesic effects of transcutaneous cranial electrical stimulation (TCES) were evaluated during N2O anesthesia in 120 unpremedicated patients, prior to urologic or general surgical operations. The patients were divided into 6 groups of 20 each with respect to the concentration of N2O in O2 they were allowed to breathe (75, 62.5 and 50%) and to whether or not they were stimulated with TCES. Recordings of heart and respiratory rates, systolic arterial blood pressure and minute ventilation were made prior to and after 20 min of N2O, and 1 min later following application of a Kocker clamp to the upper inner thigh for 1 min. The presence or absence of movement during the painful stimulus, memory of the painful stimulus and postanesthetic pain at the clamp site (20 min after anesthesia) were also evaluated. Patients who received TCES had significantly lower incidences of movement, memory of the painful stimulus and postanesthetic pain at the stimulation site at each N2O concentration than patients not getting TCES. TCES did not alter circulatory and respiratory dynamics prior to painful stimulation and prevented an increase in arterial blood pressure during painful stimulation in patients receiving 50% N2O. Apparently, TCES significantly increases the analgesic potency of N2O and probably also the depth of anesthesia.