Nitrous oxide in emergency medicine

O’Sullivan, I; Benger, Jonathan

doi:10.1136/emj.20.3.214

Cited by 56 publications

(28 citation statements)

References 46 publications

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“…Nitrous oxide is a weak volatile anaesthetic with a minimum alveolar concentration (MAC) of 104%, achievable only in hyperbaric environments [17]. Nitrous oxide is capable of producing mild sedation and analgesia, and has been shown to be safe and effective for use in a variety of practice environments including colonoscopy, transoesophageal echocardiography, transrectal prostate biopsy, emergency department procedures and labour pain management [10][11][12][13][14]18].…”

Section: Discussionmentioning

confidence: 99%

“…An ideal sedative agent would not clinically affect the patient's IOP, as this could lead to inappropriate management decisions with potential long-term visual consequences. Nitrous oxide has been shown to be safe and effective for sedation and analgesia during a variety of procedures [10][11][12][13][14]. In this study, we investigated the effect of N 2 O on the IOP of healthy adult volunteers as a preliminary step to exploring the utility of N 2 O for use in 'examinations under anaesthesia' (EUA) for the measurement of IOP.…”

mentioning

confidence: 99%

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The effect of nitrous oxide on intra‐ocular pressure in healthy adults*

Lalwani¹,

Fox²,

et al. 2012

Anaesthesia

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SummaryMany anaesthetic agents affect intra-ocular pressure, yet little is known about nitrous oxide and intra-ocular pressure. This study assessed the effect of nitrous oxide on intra-ocular pressure in 20 healthy adult volunteers. The intra-ocular pressure was measured at baseline, while breathing a 70:30 mix of nitrous oxide and oxygen for 12 min, and then while breathing room air for 15 min. A linear mixed effects model was used to assess change in intra-ocular pressure over time. There was no significant difference in intra-ocular pressure between baseline and during or after nitrous oxide inhalation. Several differences in intra-ocular pressure were noted between internal time-points: pressure increased by 2.4 mmHg between 3 and 6 min of breathing nitrous oxide (p = 0.01); it increased by 1.4 mmHg between 3 and 9 min of breathing nitrous oxide (p = 0.046); and it decreased by 2.2 mmHg between 6 min of breathing nitrous oxide and 15 min of breathing room air (p = 0.035). This study indicates that nitrous oxide inhalation does not significantly change intra-ocular pressure from baseline values in a population of healthy adults. Accepted: 25 October 2011There have been few studies to assess the effect of nitrous oxide (N 2 O) on intra-ocular pressure (IOP) [1]. This is an important question, as many anaesthetic agents produce clinically significant changes in IOP. Volatile agents like halothane, isoflurane and sevoflurane have been shown to decrease IOP, as has the intravenous anaesthetic agent propofol [2][3][4]. Other drugs, such as suxamethonium, can produce an increase in IOP [5]. Several human and animal studies have peripherally investigated the effect of N 2 O on IOP, but all have used N 2 O in combination with anaesthetic agents that are known to affect IOP [6][7][8]. One report indicates that N 2 O seems to have no effect on IOP, but supporting data or references are not given [9]. To our knowledge, there are no other studies that have explored the effect of isolated N 2 O administration on IOP in humans.Reliable IOP measurements are essential for the effective management of glaucoma, yet accurate values are

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

The effect of nitrous oxide on intra‐ocular pressure in healthy adults*

Lalwani¹,

Fox²,

et al. 2012

Anaesthesia

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“…55 Early pregnancy is therefore a contraindication to the use of N 2 O. 5 Ironically, in one study from 2003 midwives were exposed to relatively high environmental concentrations of N 2 O, which often exceeded occupational exposure limits. 56 …”

Section: Gastrointestinal Effectsmentioning

confidence: 99%

“…5 Anaesthetic opinion has been divided as to whether it should still be used. 6 It may not be an effective analgesic for women in labour -in one (small but widely quoted) trial of analgesia in early labour, compressed air was of similar efficacy.…”

Section: Historymentioning

confidence: 99%

The adverse effects of nitrous oxide

Ferner

Mackenzie²,

Aronson³

2014

Adverse Drug Reaction Bulletin

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“…Pain management at this early phase of care will typically be based on the intravenous administration of potent opioids. Inhaled nitrous oxide (entonox, a 50%/50% nitrous oxide/oxygen mixture) has a fast onset and offset and has been used for years by many ER services [27]. When used, and when no contraindication exists, it is a safe and effective way to ameliorate pain.…”

Section: Pain Care In the Emergency Departmentmentioning

confidence: 99%

Pain management and regional anaesthesia in the trauma patient

Davidson

Ginosar

Avidan

2005

Current Opinion in Anaesthesiology

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Educating the emergency room staff to perform early routine assessment of pain and to be familiar with the administration of analgesia are key elements to improved pain management in trauma. Peripheral nerve block techniques should be practised by emergency room staff. If simple techniques are chosen, competence can be achieved with short, focused training sessions. Further developments are needed in order to provide safer and more effective analgesia to the trauma patient.

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Nitrous oxide in emergency medicine

Cited by 56 publications

References 46 publications

The effect of nitrous oxide on intra‐ocular pressure in healthy adults*

The effect of nitrous oxide on intra‐ocular pressure in healthy adults*

The adverse effects of nitrous oxide

Pain management and regional anaesthesia in the trauma patient

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