Role of Nitrous Oxide in Ambulatory Anaesthesia

Abstract

As the oldest anaesthetic still in routine use, the continued role of nitrous oxide is frequently questioned. There are a few well-defined situations in which nitrous oxide is contraindicated or undesirable; it is environmentally damaging and known to be toxic with prolonged exposure. However, evidence of serious harm is relatively lacking and mostly relates to prolonged and major surgery. In the ambulatory setting, the adverse effects of nitrous oxide are more limited and of minimal clinical relevance. Furthermore, there are numerous benefits which are not easily replicated by possible alternatives. Specifically, nitrous oxide improves the quality, speed and safety of induction of anaesthesia, enhances the quality of the maintenance phase, facilitates faster recovery and may reduce the occurrence of chronic postoperative pain, all with minimal adverse effects and while also reducing overall costs. Except in very specific circumstances, the minimal disadvantages and considerable benefits suggest that nitrous oxide still retains a valuable place in modern ambulatory anaesthesia.