China
Africa
Explore chapters and articles related to this topic
Answers
Published in Ken Addley, MCQs, MEQs and OSPEs in Occupational Medicine, 2023
Nitrous oxide is classified as a pregnancy risk group Category C medication, meaning that there is a risk of foetal harm if administered during pregnancy. Chronic work-related exposure to high levels of nitrous oxide may cause increased risk of neurologic, renal and liver disease and increased risk of miscarriage and fertility issues among female dental assistants where ‘scavenging equipment’ is not used. The Public Health England study suggested the rate of reproductive disorder was closer to 30%. High-level carbon disulphide exposure will be directly toxic, but it is recognised that low-level chronic exposure can have an effect on male libido. Male semen and sperm quality can be affected by psychological stress. The Health, Safety and Welfare Regulations were introduced in 1992 in Great Britain.
Analgesia and Anaesthesia
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Nitrous oxide is a colourless, non-irritant gas administered by inhalation. It is a potent analgesic that is not metabolized—it is simply administered and eliminated rapidly via the lungs. Nitrous oxide has a dose-dependant effect and theoretically 100% nitrous oxide could almost produce anaesthesia, but without oxygen it would obviously cause immediate hypoxia. There have been cases where patients have suffered harm or death due to inhalation of pure nitrous oxide.
Nonopioid and Adjuvant Analgesic Agents
Published in Pamela E. Macintyre, Stephan A. Schug, Acute Pain Management, 2021
Pamela E. Macintyre, Stephan A. Schug
Bone marrow toxicity is progressive but also reversible and almost completely preventable by administration of folinic acid (Oussalah et al, 2019). Neurotoxicity resulting from nitrous oxide use is rare, but it can develop rapidly and may be irreversible. The clinical features are the same as those seen with a vitamin B12 deficiency-induced subacute combined degeneration of the spinal cord leading to numbness, paresthesia, ataxia, and spasticity. The risk of this complication is significantly increased in patients with a preexisting vitamin B12 deficiency (for example, those who are vegetarians or elderly), and the deficiency may be subclinical, that is, detectable only by measuring vitamin B12 blood levels.
Evidence-Based Guidelines for Prehospital Pain Management: Recommendations
Published in Prehospital Emergency Care, 2023
George Lindbeck, Manish I. Shah, Sabina Braithwaite, Jonathan R. Powell, Ashish R. Panchal, Lorin R. Browne, Eddy S. Lang, Brooke Burton, Jeffrey Coughenour, Remle P. Crowe, Hannah Degn, Mary Hedges, James Gasper, Kyle Guild, Connie Mattera, Sandra Nasca, Peter Taillac, Mark Warth
The panel finds that there is insufficient evidence to make a recommendation regarding this question. Nitrous oxide has been used in the prehospital setting for decades so there is experiential evidence supporting feasibility. A retrospective study and review described its use in prehospital care, and suggested that it might be safe enough for use by non-certified or lay responders (30). The equipment required for administration is somewhat complex and does involve significant acquisition cost relative to opioid administration, which could present a barrier to its introduction for some EMS agencies. Administration of nitrous oxide is limited to patients who can understand instructions and cooperate with self-administration. Nitrous oxide is inappropriate in some clinical settings, (e.g. bowel obstruction, pneumothorax). As with other interventions, the availability of a non-opioid analgesic option may be perceived as beneficial for patients who are intolerant or allergic to available opioids, or who would prefer to avoid opioid analgesics. The panel did not make a recommendation for this question based on an inadequate, rather than equivocal, evidence base.
Does vitamin B12 deficiency explain psychiatric symptoms in recreational nitrous oxide users? A narrative review
Published in Clinical Toxicology, 2021
Michelle C. Paulus, Anjali M. Wijnhoven, Gerdinique C. Maessen, Shannon R. Blankensteijn, Marcel A. G. van der Heyden
Nitrous oxide is clinically used in dentistry, ambulance services, and childbirth. It was regarded as one of the safest general anesthetics until 1956, when Lassen et al. [9] reported the potential risk for bone marrow suppression with nitrous oxide anesthesia. Following several investigations, risks related to occupational exposure appear to be low with correct use. Recreational use is more hazardous due to higher dosage per day and more frequent consumption [10]. The most common manifestation of nitrous oxide intoxication is subacute combined degeneration of the spinal cord, which may be marked by paresthesia, muscle weakness, and ataxia [11]. Other complications of nitrous oxide abuse include megaloblastic anemia, pulmonary infiltration and emphysema, pneumomediastinum, hyperpigmentation, and frostbite to the mouth [12,13]. Numerous nitrous oxide-induced deaths have been reported [7]. These deaths are usually the result of asphyxiation, secondary to the use of nitrous oxide in an unsafe manner.
Nitrous oxide misuse reported to two United States data systems during 2000–2019
Published in Journal of Addictive Diseases, 2020
Nitrous oxide (N2O), commonly known as laughing gas or nitrous, is a colorless, non-flammable gas used as an anesthetic and analgesic, as an aerosol propellant (particularly as a whipping agent for cream), and in the automotive industry.1,2 Individuals may inhale nitrous oxide as a recreational intoxicant due to its euphoric, dissociative, and sometimes hallucinogenic effects. These effects are rapidly induced, within ten seconds of inhalation.3 Within years after its discovery by Joseph Priestly in the late 1700s, nitrous oxide had been misused for recreational purposes, and reports of nitrous oxide misuse have been reported in the published literature for decades.4–6 The National Survey on Drug Use and Health (NSDUH) in the United States (US) found that past year use of nitrous oxide among past year inhalant initiates age 12-17 years declined from 31.6% in 2002 to 16.3% in 2007.7 A 2014 Global Drug Survey (GDS) found a 29.4% lifetime prevalence of nitrous oxide use among US respondents.8 Among all intentional abuse by inhalation exposures reported to US poison centers during 1993-2008, 902 (2.5%) were due to nitrous oxide.9 It has been reported that nitrous oxide misuse is increasing.1,10