Nitrous Use Research Articles

Use of Nitrous Oxide in Obstetrics

The introduction of nitrous oxide in a labor and delivery unit provides laboring patients with an additional option for coping with labor discomfort and anxiety. The use of nitrous oxide has been found to be helpful to patients who are coping with labor until the birth or until they request an epidural. Nitrous provides the opportunity to continue to remain ambulatory within their room, which may facilitate fetal descent. Patients’ preferences should be respected, and a wide variety of strategies should be available to meet each patient’s unique wants and needs. Nitrous oxide is an easily accessible alternate method to intravenous narcotics or regional anesthesia and may be amenable to patients who are hesitant to use other methods of coping in labor. Our PICO question was, in laboring patients, does the option of nitrous oxide prolong the time to regional anesthesia as measured by dilation progress prior to regional anesthesia administration or discontinuation of nitrous use?

The Problem of Pain, the Power of Presence, and the Appeal of Nitrous

Many believe that better pain relief in labor is significant to increased patient satisfaction. Exploring and prioritizing patients’ values and expectations for pain relief and labor coping, however, may involve several options. Our hospital faced the challenge of offering an option for women other than neuraxial anesthesia and intravenous narcotics. A nursing leader was tasked with the initiation of nitrous oxide analgesia in a regional perinatal center's labor and delivery unit. This was a new initiative for nitrous use in our inpatient hospital setting outside of the operating rooms. Our novel approach implemented more than providing information and training on nitrous oxide use, but rather a reinvigoration of the essential role of the nurse in labor support with a presentation and discussion exploring The Problem of Pain, The Power of Presence and the Appeal of Nitrous. Research was explored on labor pain, coping, suffering, patient satisfaction, and the impact of nursing care in those areas. The project involved consultation and collaboration among multiple team members, including nursing leaders, obstetric providers, anesthesia personnel, hospital administration, accreditation and quality, facilities, clinical engineering, fire safety, legal representatives, and information technology liaisons. Additionally, guidelines, patient agreement forms, educational materials, competencies, training, and inservices on the equipment were completed. After 1 year of preparation, nitrous oxide use began August 29, 2018. Approximately 150 patients have since used it. We provide this alternative option for patients who desire alternative analgesia to intravenous medications or neuraxial anesthesia for their labor and birth. Key lessons learned and hurdles encountered in the nitrous journey are explored. Nursing leaders and educators should take advantage of captive audiences with new initiatives to reinvigorate key nursing principles of clinical excellence, integrity, and compassion. Gathering the support of key stakeholders and interested team members is essential to the effective and safe implementation of nitrous oxide. Guidelines and tools related to nitrous oxide that clearly outline contraindications for use, patient counseling and monitoring, equipment set-up, and appropriate patient use are imperative to patient and staff safety.

What makes a good flap go bad?: A critical analysis of the literature of intraoperative factors related to free flap failure

The purpose of this article is to discuss the various factors related to poor outcome in free flap reconstructions of the head and neck (H&N). Free tissue transfer has become the standard reconstruction technique for complex H&N defects. With the evolution of free flap use in H&N surgery, numerous factors have been proposed that adversely affect flap outcome, many with the support of only anecdotal experience. We seek to critically review the literature to assess what evidence exists for the relation of various intraoperative factors to free flap complications. Literature review. A review of the contemporary literature (1995 to present) on free flap reconstruction of the H&N was undertaken. A PubMed search using the terms head and neck, reconstruction, free flap, microvascular, failure, complications, fluids, intraoperative, hypertension, hypotension, nitrous oxide, temperature, and morbidity in various combinations was completed. Appropriate articles were selected and analyzed. Studies report various factors thought to influence flap outcomes, often with divergent conclusions. Nonetheless, the body of evidence implicates several intraoperative factors to contribute to free flap complications including: >7 L intraoperative fluid administration, significant medical comorbidity, and prolonged operative time. There is no evidence supporting hypotension, pressors, colloids, and nitrous use in free flap failure. Although various dogmas related to the intraoperative care of free flap patients exist, including avoidance of hypotension and pressor use, there is no available clinical evidence to support these practices. Although free flap failure is uncommon, a better understanding of its causes is necessary to avoid this disastrous complication.