Severe Neurological Impairment in an Infant after Nitrous Oxide Anesthesia

McNeely, James K.; Buczulinski, Bogdan; Rosner, Diane R.

doi:10.1097/00000542-200012000-00036

Cited by 31 publications

(22 citation statements)

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“…Severe neurological impairment due to nitrous oxide inhalation has been reported in an infant during anesthesia [7]. "Whippits" are small cylindrical metal bulbs with a pierceable end that contain compressed nitrous oxide.…”

Section: Discussionmentioning

confidence: 99%

Nitrous oxide “Whippit” abuse presenting with cobalamin responsive psychosis

et al. 2006

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Introduction: Nitrous oxide is a commonly abused inhalant drug. It is known to precipitate vitamin B12 deficiency when used chronically and acutely, especially in people having marginal vitamin B12 reserve.Case report: We are presenting a case of nitrous oxide "whippit" abuse in a thirty-three-year-old male with bizarre behavior and delusions. The patient had low normal levels of vitamin B12 (202 pg/ml), but he had markedly high methylmalonyl CoA (1078 nmol/L) and homocysteine (48.4 mcmol/L). Treatment with intramuscular cobalamin led to a resolution of his psychosis.Discussion: This case report highlights the need to consider vitamin B12 deficiency in patients who arrive at a hospital with psychiatric manifestations and who report having a history of nitrous oxide exposure or abuse in the recent or remote past. A review of the literature on the neuropsychological manifestations of vitamin B12 deficiency is provided.

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Section: Discussionmentioning

confidence: 99%

Nitrous oxide “Whippit” abuse presenting with cobalamin responsive psychosis

et al. 2006

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“…There are many examples of such case reports (Schilling, 1986;Holloway & Alberico, 1990;Flippo & Holder, 1993;Kinsella & Green, 1995;Nestor & Stark, 1996;Rosener & Dichgans, 1996;Sesso et al, 1999;Marie et al, 2000;Waters et al, 2005;Cartner et al, 2007;Wu et al, 2007;Meyers & Judge, 2008;Singer et al, 2008;Somyreddy & Kothari, 2008). Those at risk of vitamin B12 deficiency include some vegetarians (in particular vegans), the newborn of vegetarian mothers, patients with GI pathology, elderly people or patients taking PPIs and H2 blockers, and alcoholics (Schilling, 1986;Rosener & Dichgans, 1996;Nilsson-Ehle, 1998;Schenk et al, 1999;Carmel, 2000;McNeely et al, 2000;Sanders et al, 2008). In individuals who are not vitamin B12 deficient, larger quantities or more prolonged use of N 2 O seems to be required before neurotoxicity is seen.…”

Section: Toxicitymentioning

confidence: 99%

Safety of opioid patch initiation in Australian residential aged care

Gadzhanova

Roughead

Pont

2015

Medical Journal of Australia

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Objective: To explore opioid use by aged care facility residents before and after initiation of transdermal opioid patches. Design: A cross‐sectional cohort study, analysing pharmacy data on individual patient supply between 1 July 2008 and 30 September 2013. Setting: Sixty residential aged care facilities in New South Wales. Participants: Residents receiving an initial opioid patch during the study period. Main outcome measure: The proportion of residents who were opioid‐naive in the 4 weeks prior to patch initiation was determined. In addition, the patch strength at initiation and the daily dose of transdermal patches and of additional opioids 1 month after initiation were determined. Results: An opioid patch was initiated in 596 of 5297 residents (11.3%: 2.6% fentanyl, 8.7% buprenorphine) in the 60 residential aged care facilities. The mean age at initiation was 87 years, and 74% of the recipients were women. The proportion of recipients who were opioid‐naive before patch initiation was 34% for fentanyl and 49% for buprenorphine. Most were initiated at the lowest available patch strength, and the dose was up‐titrated after initiation. Around 15% of fentanyl users and 10% of buprenorphine users needed additional regular opioids after patch initiation. Conclusions: The results suggest some inappropriate initiation of opioid patches in Australian residential aged care facilities. Contrary to best practice, a third of residents initiated on fentanyl patches were opioid‐naive in the 4 weeks before initiation.

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“…Case reports illustrate that these patients or newborns of mothers with these problems may present hematological and neurological complications after exposure to nitrous oxide 82 (D) 83,84 (C).…”

Section: Hematological and Neurological Complicationsmentioning

confidence: 99%

“…Patients with vitamin B 12 deficiency developed different hematological and neurological manifestations, after intraoperative exposure to nitrous oxide 82 (D) 83,84 (C). Thus, various authors raise the concern about the administration of nitrous oxide to children, given the high prevalence of metabolic defects and vitamin deficiencies in this population.…”

Section: Hematological and Neurological Complicationsmentioning

confidence: 99%