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To Use or Not to Use Nitrous Oxide

Nitrous oxide is one of the earliest anesthetics in use, yet utilization of the agent has declined over the past decades due to concerns about potential adverse effects. However, with its demonstrated efficacy and safety profile, as well as research-backed clinical benefits, nitrous oxide not only retains its role as a versatile agent with anesthetic, analgesic and sedative capabilities, it will continue to take its place in anesthetic practice.

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Articles of Interest

A narrative review of its role in clinical practice

Nitrous oxide (N2O) is one of the oldest drugs still in use in medicine. Despite its superior pharmacokinetic properties, controversy remains over its continued use in clinical practice, reflecting in part significant improvements in the pharmacology of other anaesthetic agents and developing awareness of its shortcomings.

Biologic Effects of Nitrous Oxide: A Mechanistic and Toxicologic Review

Nitrous oxide is the longest serving member of the anesthesiologist's pharmacologic armamentarium but remains a source of controversy because of fears over its adverse effects.

Controlling Exposures to Nitrous Oxide During Anesthetic Administration

Data from animal studies demonstrate that exposure to N2O may cause adverse reproductive effects. Studies of workers exposed to N2O have reported adverse health effects such as reduced fertility, spontaneous abortion, and neurological, renal, and liver disease. The recommendations in this Alert should therefore be followed to minimize worker exposures.

Nitrous Oxide and the Inhalation Anesthetics

Nitrous oxide is the most commonly used inhalation anesthetic in dentistry and is commonly used in emergency centers and ambulatory surgery centers as well. When used alone, it is incapable of producing general anesthesia reliably, but it may be combined with other inhalation and/or intravenous agents in deep sedative/general anesthestic techniques. However, as a single agent, it has impressive safety and is excellent for providing minimal and moderate sedation for apprehensive dental patients.

Nitrous oxide as an inhalation anesthetic

Current research indicates that the analgesic effect of N2O appears to be initiated by stimulated neuronal release of endogenous opioid peptides, with subsequent activation of opioid receptors and descending GABA and noradrenergic pathways that modulate nociceptive processing at the spinal level.

Nitrous oxide in modern anaesthetic practice

Nitrous oxide has global warming and ozone depletion potential and its concentration in the theatre environment is regulated.

Nitrous Oxide is an Effective and Safe Anesthetic

Nitrous oxide has been used for more than a century and given to about two billion patients. Its low tissue solubility (and therefore rapid kinetics), low cost, and minimal cardiorespiratory complications have made nitrous oxide by far the most commonly used general anesthetic in history.

Nitrous Oxide – More Harm than Good?

Nitrous oxide has been used in clinical practice longer than any other anesthetic in use today. In pediatric anesthesia, it continues to be a commonly used adjunct during inhalation inductions. It is also commonly used to “smooth out” emergence despite concerns for diffusion hypoxia, methionine synthase inhibition and bubble expansion. Given the alternatives available in modern anesthesia practice, nitrous oxide offers little if any clinical advantage. This article discusses the contribution of nitrous oxide to greenhouse gas emissions and provides specific practice recommendations that can help to eliminate the use of nitrous oxide

Nitrous Oxide-Oxygen: A New Look at a Very Old Technique

Discovered in 1772, nitrous oxide was, for almost 70 years, a recreational drug. It was not until Dec. 10, 1844, in Hartford, Conn., at a traveling “popular science” exhibition that the potential of nitrous oxide to relieve pain was appreciated.

The Safety Of Nitrous Oxide In Anesthesia

Also known as laughing gas, nitrous oxide is a fast-acting anesthetic agent that is safe for use during a variety of medical and dental procedures, including surgery. Its anesthetic versatility has been recognized for more than 200 years, and it is one of the most commonly used general anesthetics in the world today.

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StatPearls

Nitrous oxide is an odorless, colorless, non-flammable gas. While nitrous oxide is not flammable, it will support combustion to the same extent as oxygen. It leads to a state of euphoria, explaining its nickname, ‘laughing gas.’ Nitrous oxide is the least potent inhalational anesthetic. Compared to other anesthetic agents, nitrous oxide causes minimal effects on respiration and hemodynamics. It cannot be a sole anesthetic agent and is often combined with a more potent and volatile anesthetic.