Complications caused by nitrous oxide in dental sedation

Abstract

The first clinical application of nitrous oxide (N2O) was in 1844, by an American dentist named Horace Wells who used it to control pain during tooth extraction. Since then, N2O has shared a 170-year history with modern dental anesthesia. N2O, an odorless and colorless gas, is very appealing as a sedative owing to its anxiolytic, analgesic, and amnestic properties, rapid onset and recovery, and, in particular, needle-free application. Numerous studies have reported that N2O can be used safely and effectively as a procedural sedation and analgesia (PSA) agent. However, N2O can lead to the irreversible inactivation of vitamin B12, which is essential for humans; although rare, this can be fatal in some patients.

One month of nitrous oxide abuse causing acute vitamin B12deficiency with severe neuropsychiatric symptoms

“…N 2 O-induced neurologic pathology was first described in 1978 9. N 2 O toxicity from B 12 depletion can occur anywhere from 2 days to 2 months after starting use 6. Our patient developed it after 1 month of heavy use.…”

“…Having been first synthesised in 1772, It is appealing in its anxiolytic, amnestic and analgesic properties. In fact, in 1844, American dentist Horace Wells started to employ it as an analgesic for extracting teeth 6…”

Effect of sevoflurane anaesthesia on nasal mask in endoscopic retrograde cholangiopancreatography: is it a preferred alternative?

“…Under general anaesthesia, the patient's airway is safer and hemodynamic instability can be controlled better. Nitrous oxide and nasal masks, as well as adequate sedation levels, are frequently applied in patients with paediatric dental problems [2]. Obstructive Sleep Apnoea Syndrome (OSAS) Background/aim: Endoscopic retrograde cholangiopancreatography (ERCP) often requires deep sedation.…”

Acute Cervical Myelopathy Following Laughing Gas Abuse

“…Laughing gas is the common name for nitrous oxide (N 2 O),1 and is typically used as an inhaled anesthetic agent in the field of surgery or dentistry 23. It is also used for recreational purposes due to its euphoric effects when inhaled.1-3 However, prolonged N 2 O abuse can lead to various neurologic manifestations including subacute combined degeneration, myeloneuropathy, or myelopathy without peripheral neuropathy due to vitamin B12 deficiency 4.…”

“…It is also used for recreational purposes due to its euphoric effects when inhaled.1-3 However, prolonged N 2 O abuse can lead to various neurologic manifestations including subacute combined degeneration, myeloneuropathy, or myelopathy without peripheral neuropathy due to vitamin B12 deficiency 4. Vitamin B12 is an essential cofactor in the synthesis of the myelin sheath, and can be inactivated irreversibly by exposure to N 2 O 13. Chronic myelopathy following long-term exposure to N 2 O has already reported,14 and subacute myelopathy can also occur 2 to 6 weeks after the surgery under anesthesia with N 2 O 2.…”