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Nitrous Oxide — Application in Modern Anesthesia

  • Patient Safety in Anesthesia (SJ Brull and JR Renew, Section Editors)
  • Published:
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Abstract

Purpose of Review

This review paper shows the controversies of using nitrous oxide in anesthesia of different patient populations. It provides information on nitrous oxide’s potential side effects when used in modern anesthesia during surgery.

Recent Findings

The ENIGMA I and ENIGMA II studies showed a significantly increased risk of postoperative nausea and vomiting after nitrous oxide administration. The theory is that nitrous oxide administered at pediatric age may accelerate neuronal apoptosis and lead to cerebral toxicity and behavioral and learning disorders later in life. The side effects associated with the use of nitrous oxide are based on megaloblastic changes associated with vitamin B12 deficiency and reduced methionine synthesis.

Summary

In recent years, there have been recommendations to eliminate nitrous oxide from medical use due to its toxicity, possible increase in morbidity and mortality, and adverse environmental effects. Nevertheless, some authors promote its use, mainly because of its analgesic effect. Nitrous oxide can be used for analgesia during epidural catheter placement, labor, and postpartum procedures because it crosses the placenta and is rapidly eliminated in newborns at the onset of respiration. Its widespread use in minor pediatric procedures has been described. Currently, there is insufficient evidence to support or refute the continued use of nitrous oxide in medical practice. Most of the available data show that nitrous oxide is obsolete as an anesthetic gas, which unfortunately reduces the need for its continued use in anesthesia.

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Authors and Affiliations

  1. Clinic for Anesthesiology and Intensive Care, University Clinical Hospital Center “Dr Dragisa Misovic Dedinje”, Belgrade, Serbia

    Nemanja Dimic, Marko Djuric, Irina Nenadic, Suzana Bojic, Marina Bobos, Ana Janicijevic, Milica Mijovic & Predrag Stevanovic

  2. Medical Faculty, University of Belgrade, Belgrade, Serbia

    Nemanja Dimic, Marko Djuric, Irina Nenadic, Suzana Bojic & Predrag Stevanovic

  3. Institute for Orthopedic Surgery “Banjica”, Belgrade, Serbia

    Milica Bojanic

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  1. Nemanja Dimic
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Dimic, N., Djuric, M., Nenadic, I. et al. Nitrous Oxide — Application in Modern Anesthesia. Curr Anesthesiol Rep 13, 117–123 (2023). https://doi.org/10.1007/s40140-023-00554-4

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