Nitrous oxide anxiolysis for elective cesarean section

Vallejo, Manuel C.; Phelps, Amy L.; Shepherd, Craig J.; Kaul, Bupesh; Mandell, Gordon L.; Ramanathan, Sivam

doi:10.1016/j.jclinane.2005.01.009

Cited by 16 publications

(17 citation statements)

References 21 publications

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“…It has been reported that performing caesarean section under spinal anesthesia is associated with too much anxiety (2, 3). This very fact that caesarean section is performed on the patient's abdomen while she is awake can cause anxiety (3, 4).…”

Section: Introductionmentioning

confidence: 99%

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Nitrous Oxide Effect on Relieving Anxiety and Pain in Parturients Under Spinal Anesthesia for Caesarean Section

Manouchehrian

Bakhshaei

2014

Anesth Pain Med

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Background:Anxiety is an unpleasant experience that may have adverse effects on the process of anesthesia, cesarean delivery, recovery period and postoperative pain. Anxiety can also affect maternal satisfaction of the medical cares that provided by the medical team.Objectives:To compare the effects of inhalational 50% nitrous oxide (N2O) with oxygen on reducing anxiety and pain in parturients who have undergone caesarean section under spinal anesthesia.Patients and Methods:In this double-blind clinical trial, 56 primigravid parturients were randomly assigned into two groups according to the operating list schedule. The experimental group received inhalational 50% N2O three minutes before spinal anesthesia to the end of delivery. The control group received only oxygen. Flow meters were covered by a dark shield and monitored by an experienced nurse anesthetist. Pain and anxiety of patients were measured using visual analogue scale (VAS) by another nurse who was neither involved in the anesthetic process nor aware of the participants' allocation and inhalation agents. Data regarding sedation level, ephedrine use, nausea, vomiting, and neonate Apgar score were recorded as well.Results:Overall mean ± SD of anxiety VAS scores was 1.77 ± 1.5 in the experimental group and 3.12 ± 1.73 in the control groups (P = 0.003). The mean ± SD of pain VAS scores of the experimental and control groups were 0.82 ± 1.5 and 1.64 ± 1.45, respectively (P = 0.042). No significant differences were seen regarding blood oxygen saturation, neonate Apgar scores, total used ephedrine, operation time, delivery time, nausea, and vomiting between the two studied groups.Conclusions:Inhalation of 50% N2O can significantly decrease anxiety (without clinically significant side effects) compared with O2 inhalation in parturients who have undergone caesarean section under spinal anesthesia.

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Section: Introductionmentioning

confidence: 99%

“…This very fact that caesarean section is performed on the patient's abdomen while she is awake can cause anxiety (3, 4). Therefore, relieving anxiety may change caesarean section and childbirth into a pleasant experience (1).…”

Section: Introductionmentioning

confidence: 99%

Nitrous Oxide Effect on Relieving Anxiety and Pain in Parturients Under Spinal Anesthesia for Caesarean Section

Manouchehrian

Bakhshaei

2014

Anesth Pain Med

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“…[15][16][17] For this reason, relieving anxiety and minimizing side effects may provide gladsome C/S and childbirth. 15 The relationship between anxiety and increased sympathetic activity has been shown in previous studies investigating heart variability and postural blood pressure changes.…”

Section: Discussionmentioning

confidence: 99%

“…17,22 In addition, sedation with either propofol or midazolam has been demonstrated to provide a high and comparable satisfaction during SA for C/S. 23 Thiopental was reported to be a safe and effective drug for sedation and premedication when rectally used in pediatric population.…”

Section: Discussionmentioning

confidence: 99%

Effects of Sedation on Spinal Anesthesia-induced Maternal Hypotension in Preoperatively Anxious Parturients Underwent Urgent Category-1 Cesarean Section: A Historical Cohort Study

Şahan¹,

Şalvız²,

Alay³

et al. 2017

Turkiye Klinikleri J Anest Reanim

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A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : This study was designed to investigate the effect of sedation on maternal hypotension in preoperatively anxious parturients underwent urgent category-1 Cesarean section (C/S) under spinal anesthesia (SA). M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : After ethics committee approval, data of 1824 parturients underwent C/S were reviewed from the surgical database and patient charts. Parturients with high preoperative anxiety scores (VAS-A)≥70) underwent C/S under SA with thiopental 2 mg/kg (if necessary additional 50 mg) sedation until reaching Ramsay sedation score≥3 (Group S, n=49), and without any other type of sedation (Group NS, n=53) were included in the study. All parturients received SA with hyperbaric bupivacaine 0.5% 2.5 mL. Hemodynamic parameters and maximum systolic arterial pressure (SAP) reductions (%) from the baseline were recorded. Maternal hypotension (SAP≥30% decrease or <100 mmHg) and bradycardia (heart rate <55 beats/min) incidences, required ephedrine (5mg IV bolus) and atropine (0.5 mg IV bolus) doses, and newborn Apgar scores were also analyzed. R Re es su ul lt ts s: : Fifty-nine parturients' data (Group S: 29 and Group NS: 30) were analyzed. The maximum SAP reductions were 23±12.8% and 30.8±16.1% in Groups S and NS, respectively (p=0,044). Hypotension was observed in 5 (17,2%) parturients of Group S and 15 (50%) of Group NS (p=0.012, 95% CI 0,14-0,82; relative risk=0,344). Ephedrine requirement was 17±4,4 mg and 25±7,4 mg in Groups S and NS, respectively (p=0,04). Incidence of bradycardia, required atropine dose and newborn Apgar scores were similar in both groups (p>0,05). C Co on nc cl lu us si io on ns s: : The maximum SAP reduction, hypotension incidence and required ephedrine doses were lower in thiopental sedation used preoperatively anxious parturients who underwent category-1 C/S under SA. K Ke ey yw wo or rd ds s: : Cesarean section; anxiety; anesthesia, spinal; conscious sedation; thiopental Ö ÖZ ZE ET T A Am ma aç ç: : Bu çalışma, preoperatif dönemde anksiyöz olup spinal anestezi (SA) altında acil kategori-1 sezaryen (C/S) operasyonu geçiren gebelerde, sedasyonun hipotansiyona etkisini araştırmak için planlanmıştır. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Etik kurul onayı alındıktan sonra, C/S operasyonu geçiren 1824 gebenin verileri cerrahi arşiv ve hasta dosyaları aracılığıyla incelendi. Preoperatif anksiyete skoru (VAS-A)≥70) yüksek olup SA altında C/S geçiren gebelerden Ramsay sedasyon skoru ≥3 olacak şekilde tiyopental 2 mg/kg (gereğinde 50 mg ek doz) uygulanan hastalar (Grup S, n=49) ve herhangi bir sedasyon uygulanmayan hastalar (Grup NS, n=53) çalışmaya dahil edildi. Tüm gebelere, 2,5mL %0,5'lik hiperbarik bupivakain ile SA uygulandı. Hemodinamik parametreler ve bazale göre sistolik arteryal basınçtaki (SAB) maksimum düşüşler (%) kaydedildi. Maternal hipotansiyon (SAB'ın ≥%30 düşmesi veya <100 mmHg olması) ve bradikardi (kalp hızı <55 atım/dk) insidansları, efedrin gereksinimi (5 mg IV b...

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“…It is widely used during labour as well [10,11] but its analgesic efficacy varies [11]. Its anxiolytic efficacy has been demonstrated during dental procedures [12], intravenous cannulations [13], and in women undergoing Caesarean section under spinal anaesthesia [14]. The analgesic mechanism of nitrous oxide may be mediated by activation of opioid receptors and descending antinociceptive pathways; the anxiolytic effect may be mediated with activation of GABA A receptors [15].…”

Section: Introductionmentioning

confidence: 99%

Nitrous oxide analgesia for bone marrow aspiration and biopsy – A randomized, controlled and patient blinded study

Kuivalainen

Ebeling

Poikonen

et al. 2015

Scandinavian Journal of Pain

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Background and aims Bone marrow aspiration and/or biopsy (BMAB), performed under local anaesthesia in adults, is a common and often painful procedure. Anxiety is known to intensify pain during the procedure. Nitrous oxide (N2O), known for its sedative and analgesic benefit in various short medical procedures and labour pain, could be advantageous also for pain relief during bone marrow examination. N2O acts rapidly and is eliminated in a couple of minutes once the inhalation is stopped, and occasional side effects (e.g. dizziness and nausea) are mild. The aim of this study was to compare the analgesic effects of inhaled 50% mixture of nitrous oxide and oxygen to 50% oxygen during bone marrow examination. Methods In this randomized, controlled, patient and observer blinded study patients received either 50% mixture of nitrous oxide and oxygen or 50% mixture of oxygen in air during bone marrow examination, in addition to local analgesia. Both patient groups comprised 35 adult patients. Pre-procedural anxiety and procedural pain were rated on the Numeral Rating Scale (NRS 0‒10). Cognitive function was measured before and 30 min after the procedure. Possible side effects were recorded. A telephone interview was performed 24 h later. Results There were no statistically significant differences in pain scores of the procedural steps (median NRS ranging 3.0‒4.0) between the study groups. High pain scores of 8‒10 comprised 0% vs. 8.6% of the scores during infiltration, 2.9% vs. 5.7% during puncture, 11.4% vs. 14.3% during aspiration and 2.9% vs. 2.9% during biopsy in N2O and 50% O2 groups, respectively (NS). Pre-procedural anxiety (median NRS 3.5 in both groups), measured in the outpatient clinic just prior to procedure, correlated with pain intensity during bone marrow aspiration (P = 0.045). There were no significant differences between side effects. During the BMAB four patients (3 in N2O group, 1 in 50% O2 group) reported dizziness and one patient in the N2O group reported nausea. Gas inhalation did not affect the cognitive function of the participants. In both groups the majority (>80%) of the patients was satisfied with the inhalation technique. During the 24 h interview, most of the participants were pain free and they did not report any serious adverse effects. Conclusions In spite of similar moderate to strong procedural pain in both groups and no benefit of N2O, most patients were satisfied with the inhalational techniques. We assume that the bedside presence of an anaesthesiologist and the distraction caused by the inhalational arrangements introduced positive context-sensitive therapeutic effect independent of the gas used. Pre-procedural anxiety predicted pain associated with bone marrow aspiration. Implications Inhaled 50% nitrous oxide was not an effective analgesic during bone marrow examination in our unselected outpatient population. Further studies should concentrate on its use with patients predicted to be at increased risk of suffering intense pain during the procedure, such as very anxious patients o...

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Nitrous oxide anxiolysis for elective cesarean section

Cited by 16 publications

References 21 publications

Nitrous Oxide Effect on Relieving Anxiety and Pain in Parturients Under Spinal Anesthesia for Caesarean Section

Nitrous Oxide Effect on Relieving Anxiety and Pain in Parturients Under Spinal Anesthesia for Caesarean Section

Effects of Sedation on Spinal Anesthesia-induced Maternal Hypotension in Preoperatively Anxious Parturients Underwent Urgent Category-1 Cesarean Section: A Historical Cohort Study

Nitrous oxide analgesia for bone marrow aspiration and biopsy – A randomized, controlled and patient blinded study

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