Supplementation With Demerol During Nitrous Oxide Anesthesia

Brotman, Milton; Cullen, Stuart C.

doi:10.1097/00000542-194911000-00005

Cited by 20 publications

(7 citation statements)

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“…Nitrous oxide (N 2 O) is a colorless gas that is often mixed with 30% oxygen for use as an anesthetic for dental and surgical operations, and its anesthetic effect is characterized by rapid onset and high safety. Ever since “laughing gas parties” became popular in the Victorian era, N 2 O has gradually become a popular inhaled drug because of its recreational use (Becker & Rosenberg, 2008 ; Brotman & Cullen, 1949 ; Weimann, 2003 ; Nagele et al., 2015; Van Amsterdam et al., 2015 ). In recent years, recreational N 2 O use has increased significantly both in China and abroad (Randhawa & Bodenham, 2016 ; The GDS Core Research, Team ; Zheng et al., 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Analysis of clinical characteristics and prognostic factors in 110 patients with nitrous oxide abuse

Qiao

et al. 2022

Brain and Behavior

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Purpose: To review the clinical symptoms, auxiliary examination findings, and outcomes of patients with nitrous oxide (N 2 O) abuse, and analyze the factors that affect outcomes. Methods: Patients with N 2 O abuse treated in the Department of Neurology between January 2018 and December 2020 were included. The clinical data of these patients were collected, and follow-up was conducted to determine the outcomes. Results: The average age of the 110 patients with N 2 O abuse was 21.4 ± 4.2 years (range: 14-33 years). Clinical presentation primarily included neurological symptoms, such as limb numbness and/or weakness (97%), psychiatric symptoms, changes in appetite, and skin hyperpigmentation. Laboratory test results were characterized by vitamin B 12 deficiency (60%, 34 out of 57 cases) and high homocysteine level (69%, 31 out of 45 cases). Electromyography indicated mixed axonal and demyelination injury (92%, 80 out of 87 cases). Motor and sensory nerves were simultaneously involved, and injury primarily involved the lower limbs. One hundred and seven (97%) patients were clinically diagnosed with peripheral neuropathy, of whom 26 (24%) exhibited spinal abnormalities on magnetic resonance imaging, supporting a diagnosis of subacute combined degeneration. Treatment included N 2 O withdrawal and vitamin B 12 supplementation. Reexamination of six patients indicated that treatment was effective. Follow-up was completed for 51 patients. Thirty-four patients (67%) recovered completely, 17 patients (33%) had residual limb numbness, and only one patient experienced relapse. Sex was an independent prognostic factor; the outcomes of female patients were better than that of male patients. Conclusion: The recreational use of N 2 O has largely expanded among youth in recent decades, which has become a growing public health concern in China. It highlights the importance of the recognition of various clinical symptoms, particularly limb numbness and/or weakness related to the cases of N 2 O abuse. The therapeutic administration of vitamin B 12 supplementation and N 2 O withdrawal can make the overall prognosis good, especially for female patients.

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Section: Introductionmentioning

confidence: 99%

Analysis of clinical characteristics and prognostic factors in 110 patients with nitrous oxide abuse

Qiao

et al. 2022

Brain and Behavior

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“…Nitrous oxide (N 2 O), commonly known as laughing gas, is one of the most widely used anesthetic, to relieve pain and anxiety in both dental and medical applications [1]. However, N 2 O is also recreationally used by people for its euphoric and hallucinogenic effects.…”

Section: Introductionmentioning

confidence: 99%

Clinical feature and sural biopsy study in nitrous oxide-induced peripheral neuropathy

et al. 2022

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Objective The objective was to analyze the clinical characteristics and pathological characteristics of sural biopsy in nitrous oxide (N2O) -induced peripheral neuropathy. Methods We recruited 18 patients with N2O abuse-induced neurological disorders and reported their demographic data, clinical manifestations, laboratory examinations, and nerve conduction studies. Seven patients underwent sural nerve biopsy pathologic examination. Results All 18 patients had polyneuropathy, the nerve conduction results showed significant reductions in motor and sensory amplitudes, slowing of conduction velocities, and prolongation of latencies in most tested nerves compared to the controls. Toluidine blue staining of semi-thin sections of sural nerve biopsy showed decreased myelinated nerve fiber density, increased thin myelinated nerve fiber density, and axonal regeneration. Electron microscopy showed axonal degeneration and nerve regeneration. Conclusion The main manifestations of peripheral nerve damage caused by the abuse of N2O are lower limb weakness and distal sensory disorder. The nerve conduction study results demonstrated that mixed axonal and demyelinating neuropathy was the most common type of neuropathy. Sural biopsy showed the main pathological change was chronic axonal degeneration.

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“…79 N evertheless, meperidine has been used extensively along with nitrous oxide even for deep general anesthesia. 21 A systematie eoordinated effort has been made to separate the useful analgesie effeet from the undesirable effeets of morphine and meperidine by modifying their moleeules. 81 , 119 Ever sinee the strueture of morphine was identified in 1925 and its synthesis aeeomplished in 1952, numerous analgesie eompounds have been developed-some of whieh are as mueh as 1,000 times as potent and some having virtua11y no analgesie effeets.…”

Section: Intravenous Anesthesia With Neurosedatives Psychosedatives mentioning

confidence: 99%

Newer anesthetics end their uses

Dobkin

1966

Clin Pharma and Therapeutics

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Supplementation With Demerol During Nitrous Oxide Anesthesia

Cited by 20 publications

References 0 publications

Analysis of clinical characteristics and prognostic factors in 110 patients with nitrous oxide abuse

Analysis of clinical characteristics and prognostic factors in 110 patients with nitrous oxide abuse

Clinical feature and sural biopsy study in nitrous oxide-induced peripheral neuropathy

Newer anesthetics end their uses

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