Use Of Nitric Oxide Research Articles

Right iliac deep vein thrombosis and pulmonary embolism associated with recreational nitrous oxide: a case report

BackgroundThe recreational use of nitrous oxide is becoming increasingly common among teenagers and young adults. Since 2018, the use of nitrous oxide has increased exponentially and has become a public health problem.Case presentationA 23-year-old patient was referred to accident and emergency (A&E) by his general practitioner for deterioration in general condition, vomiting, diarrhea and febrile headache at 39 °C.He reported that he had been partying for a month and consuming alcohol, cannabis and nitrous oxide. Three days before the consultation, he reported increased abdominal pain in the right iliac fossa. His homocysteine concentration was 51.9 μmol/L, and his plasma methyl malonate concentration increased to 4.45 μmol/L. A thoracic and abdominal CT scan revealed right iliac venous thrombosis associated with bilateral pulmonary embolism.ConclusionNitrous oxide inhibits the activity of methionine synthetase. We therefore observed an increase in plasma homocysteine and 5-methyl-THF. The increase in homocysteine could be responsible for the pro-thrombotic activity resulting from nitrous oxide intoxication. At present, no threshold or duration of exposure has been identified as being particularly likely to cause complications. It is likely that other factors coexist, such as coagulation disorders and polymorphisms of the MHTFR gene, which can lead to hyperhomocysteinaemia, cannabis consumption, inflammatory conditions and others. Treatment is based on vitamin B12 supplementation and curative anticoagulation. Some authors also recommend folate supplementation.Consumption of nitrous oxide could be associated with arterial and venous thromboembolic disease.

Modelling technical efficiency of health systems in SADC

Efficiency is the application of resources in a way that maximizes intended results. Policymakers around the world are prioritising health system efficiency as nations strive for universal health coverage. The study used the data envelopment analysis and the Tobit regression approach, the current study evaluated the technical efficiency of the health care system and its determinants. The study established that the average efficiency of the SADC countries is 78 percent signifying high levels of inefficiencies. Further the study found that the most efficient countries were Angola, Botswana, Eswatini, Mauritius, Mozambique, and Malawi. The number of practitioners i.e. physicians and nurses, primary school graduation rates, and national income all have a beneficial impact on the efficiency of the health system. The use of nitrous oxide in agriculture and vulnerable employment have a negative impact on technical efficiency. The study recommends that SADC countries should improve on resource use to improve on technical efficiency, train more doctors, nurses, and other medical professionals. Additionally, nations should implement pro-growth policies to boost revenue to capacitate their health systems with beds and other requisite equipment.

Association of volatile substance, nitrous oxide and alkyl nitrate use with mental health in UK adolescents.

'Inhalants' have been associated with poorer mental health in adolescence, but little is known of associations with specific types of inhalants. We aimed to investigate associations of using volatile substances, nitrous oxide and alkyl nitrates with mental health problems in adolescence. We conducted a cross-sectional analysis using data from 13- to 14-year-old adolescents across England and Wales collected between September 2019 and March 2020. Multilevel logistic regression examined associations between lifetime use of volatile substances, nitrous oxide and alkyl nitrates with self-reported symptoms of probable depression, anxiety, conduct disorder and auditory hallucinations. Of the 6672 adolescents in the study, 5.1% reported use of nitrous oxide, 4.9% volatile solvents and 0.1% alkyl nitrates. After accounting for multiple testing, adolescents who had used volatile solvents were significantly more likely to report probable depressive (odds ratio = 4.59, 95% CI 3.58, 5.88), anxiety (odds ratio = 3.47, 95% CI 2.72, 4.43) or conduct disorder (odds ratio = 7.52, 95% CI 5.80, 9.76) and auditory hallucinations (odds ratio = 5.35, 95% CI 4.00, 7.17) than those who had not. Nitrous oxide use was significantly associated with probable depression and conduct disorder but not anxiety disorder or auditory hallucinations. Alkyl nitrate use was rare and not associated with mental health outcomes. Adjustment for use of other inhalants, tobacco and alcohol resulted in marked attenuation but socioeconomic disadvantage had little effect. To our knowledge, this study provides the first general population evidence that volatile solvents and nitrous oxide are associated with probable mental health disorders in adolescence. These findings require replication, ideally with prospective designs.

B-283 Biological Consequences of Nitrous Oxide Abuse: Insights from Targeted Metabolomics Investigation

Abstract Background The recreational use of nitrous oxide (N2O), commonly known as laughing gas, has experienced a notable surge in popularity in recent times. According to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), N2O is recognized as one of the most widely used psychoactive substances in Europe as of 2022. Its use also extends to Asia and America, according to literature. However, prolonged consumption of N2O has been associated with neurological complications linked to the functional inactivation of vitamin B12, disrupting One Carbon Metabolism. This study aims to explore the metabolic effects of N2O intoxication through a targeted metabolomics approach. Methods We conducted a prospective collection of clinical and biological information from 37 N2O users and 37 non-users (control group). Utilizing a targeted metabolomics method, we analyzed plasma amino acids using liquid chromatography coupled with mass spectrometry. Our statistical analysis encompassed principal component analyses, random forests, Mann-Whitney tests, Student's t-tests, and Spearman rank tests. Results Metabolomic analyses have demonstrated effective differentiation between patient groups. In comparison to controls, N2O consumers displayed reduced plasma levels of taurine, cystine, and methionine, alongside elevated plasma levels of serine and sarcosine. These findings suggest a potential influence of N2O on the cystine-methionine metabolic pathway. The decrease in methionine levels may be attributed to the decreased activity of methionine synthase (MS) due to vitamin B12 inactivation, which could partially explain the observed increase in serine levels. The rise in sarcosine levels could be explained by an increase in betaine-homocysteine S-methyltransferase (BHMT) activity. Moreover, dysfunction in cystathionine-β-synthase (CBS) or cystathionine γ-lyase (γ-CYS) may lead to the accumulation of upstream metabolites (such as serine) and a reduction in downstream metabolites (such as cysteine and taurine). Conclusions This study sheds light on potential new impacts of N2O, particularly on the plasma levels of serine, cystine, and taurine, indicating a potential modulation of enzymes involved in the conversion of homocysteine to taurine (CBS and/or γ-CYS). Additional investigations are required in a larger group of patients, which corresponds to the aims of the EFLM Task & Finish Group: Biomarkers of Diagnosis and Follow-up of Nitrous Oxide Abuse: https://www.eflm.eu/site/who-we-are/committee/science-committee/fu/tfg-biomarkers-of-diagnosis

High lifetime prevalence of regular nitrous oxide use in French medical students

ABSTRACT Background: Although nitrous oxide (N₂O) is increasingly misused recreationally, its use and risks among medical students who have professional access to it are rarely explored. Objectives: To investigate the recreational use of N₂O among medical students in Paris Region (France). Methods: This cross-sectional study used an online questionnaire distributed in 2022 through social networks, to all medical students (undergraduate student from the 2nd year of medical studies to residents until the end of the residency) from the six medical universities in Paris Region. We collected demographic characteristics, patterns of N₂O consumption, co-consumptions, and N₂O training (academic course or self-training). Factors associated with N₂O consumption and complications were analyzed using multivariable logistic regressions. Results: The questionnaires of 444 students (mean age: 25.9 years (SD = 2.69), 75.5% female, and 63.74% residents) were analyzed. Recreational N₂O consumption was reported by 71.85% of students and 20.50% consumed at least monthly. N₂O consumption was associated with being a resident (versus undergraduate student) (adjusted OR (aOR) = 3.07[1.45–6.72]; p < .01), receiving training on N₂O (aOR) = 3.13[1.84–6.24]; p < .01), and consumption of cannabis (aOR = 18.21[3.47–104.26]; p < .01), ecstasy (aOR = NA, p = .048) and poppers (aOR = 13.9[2.64–77.94]; p < .01). Complications (mainly dizziness, paresthesia and burns) were reported in 8.15% of students consuming N₂O. They were associated with consuming more than 10 balloons per intake (aOR = 6.04[1.32–25.00); p < .01) and inversely associated with receiving training (aOR = 0.35[0.14–0.86]; p = .01). Conclusions: Almost three-quarters of medical students experienced recreational N₂O consumption, particularly with poly-drug use. Given that complications were associated with high consumption and lack of education, risk training and screening for N₂O consumption could be beneficial.

Administration of Nitrous Oxide by Medical Assistants for Painful Procedures in Outpatient Pediatric Settings.

Managing pain and distress in children experiencing procedural pain is a priority in pediatric care. Nitrous oxide (pre-mixed formulation of 50% nitrous oxide to 50% oxygen) is widely used to alleviate anxiety or pain during care procedures in various medical domains. This pharmacological intervention is safe to administer to children. Administration by non-anesthesiologist personnel is widespread throughout the world, though it is almost exclusively performed by doctors and nurses. The purpose of this study is to describe the experience of nitrous oxide (N2O) use by medical assistants and safe handling during the performance of painful procedures. A retrospective study was conducted in a pediatric outpatient unit of a regional hospital, including medical and surgical consultations. Nitrous oxide was administered by medical assistants to 324 children aged 3 to 19 years. No respiratory and/or cardiovascular problems were noted. Most patients were calm and relaxed. The use of N2O for minor procedures in children in a pediatric outpatient unit improved pain management through administration by medical assistants with a high level of satisfaction from patients, parents and health professionals. This study suggests that the use of nitrous oxide by trained medical assistants can be safe, feasible and effective within the specific context of this study.

Use of Nitrous Oxide During Prostate Biopsies: A Meta-analysis of Randomized Controlled Trials

Use of Nitrous Oxide During Prostate Biopsies: A Meta-analysis of Randomized Controlled Trials

Frostbite injuries related to recreational nitrous oxide use: incidence, management, and complications in a Swedish case series

Background: Nitrous Oxide (N2O) use in the recreational setting has been increasing in Sweden and Europe and therefore also related injuries. We aimed to investigate incidence, management, and surgical outcomes of frostbite injury (FI) related to N2O use. Material and MethodAll patients in a 22-month period, 2021-2022 presenting with FI related to N2O abuse from two plastic surgery clinics (one national burn centre) were identified. Data regarding patient comorbidity, mechanism of injury, initial management, treatment, and follow up were investigated. Complications following surgery were categorized into minor (treated in outpatient setting), and major (requiring reoperation). Results: In total 9 patients were identified, and 5 patients gave consent and were included. Direct contact with gas canister was the most common injury mechanism (n=4). All but one patient contracted full thickness injuries, and these four patients later required surgical intervention. The medial thigh was the most common area of injury. Outpatient clinic visits were common (mean 4.8 visits/patient). Surgical complications were common, and all operated patients were diagnosed with a minor complication and half of them also with a major complication (wound dehiscence and scar contracture). Conclusion: Frostbite injuries arising from recreational N2O are complex and often requiring surgical intervention and leading to complications. With the increasing incidence of N2O abuse in Sweden, further research is crucial to address emerging public health concerns and optimize treatment strategies for these distinctive injuries.

Methoxyflurane analgesia for outpatient hysteroscopy: A double-blind, randomised, controlled trial.

Despite clinical and economic benefits, pain during outpatient hysteroscopy (OPH) remains a barrier to use. There is a lack of evidence to support routine use of one analgesic over another versus no analgesic. To study the efficacy and safety of methoxyflurane analgesia during OPH. A single-centre, randomised, double-blind, placebo-controlled experiment was performed; 90 patients were randomly assigned (1:1). Participants allocated to the treatment group (cases) received 3 mL of methoxyflurane through an inhaler. The control group received a placebo. The primary outcome was a mean difference in pain, via a change in Visual Analog Scale (VAS) score from baseline at diagnostic hysteroscopy. Secondary outcomes were a mean difference in VAS score with any subsequent operative procedures; a mean difference in VAS score at 15 min post-procedure; participant and clinician-reported adverse effects and events; and participant-reported procedure acceptability, adjuvant nitrous oxide (N2O2) use and a composite of 'distress'. During diagnostic hysteroscopy, there was a mean difference of 11.5 mm/100 (95% confidence interval (CI) 0.08-22.95), P = 0.05, with the lower score in the cases, compared with controls. During subsequent operative procedures, there was a mean difference of 15 mm/100 (95% CI 2.71-28.22), P = 0.02, with the lower pain score in the cases, compared with controls. There was no significant difference in pain 15 min post-procedure, participant- and clinician- reported adverse effects and events, procedure acceptability and the 'distress' composite. Methoxyflurane significantly reduced pain during OPH compared with placebo, for diagnostic as well as operative procedures. Furthermore, methoxyflurane was well tolerated, with no adverse events.

When Euphoria Turns to Neuropathy: Vitamin B12 Deficiency Related to Nitrous Oxide

Background: Nitrous oxide is a widely abused inhalant known for its rapid onset of euphoric sensations. Chronic use, however, can result in functional vitamin B12 deficiency, causing megaloblastic anemia, peripheral neuropathy, and subacute combined degeneration (SCD) of the spinal cord. Case Presentation: This case report examines a 43-year-old male with a history of attention-deficit/hyperactivity disorder (ADHD) and chronic back pain, who presented with neurological symptoms secondary to chronic nitrous oxide use, subsequent B12 deficiency. The patient reported a one week history of lower extremity swelling, paresthesias, and vertigo. He admitted to daily nitrous oxide use for the past month. Neurological examination revealed ataxia, impaired proprioception, and a positive Romberg test. Laboratory studies showed macrocytic anemia and a severely decreased B12 level. MRI of the cervical spine revealed T2 hyperintensity in the dorsal columns, consistent with SCD. He was treated with intramuscular B12 and advised to discontinue nitrous oxide use. At a three-month follow-up, significant neurological improvement was noted, allowing him to return to work. Conclusion: Chronic nitrous oxide use can lead to functional B12 deficiency and subacute combined degeneration, a potentially reversible condition if treated early. Differential diagnoses include pernicious anemia, malabsorption syndromes, and other neurological disorders. Prompt diagnosis through serum B12, methylmalonic acid, homocysteine levels, and spinal imaging is essential to prevent permanent neurological damage. Nitrous oxide abuse is an emerging cause of B12 deficiency. Early recognition and intervention are essential for recovery. Healthcare providers should consider B12 deficiency in patients presenting with neurological symptoms and a history of nitrous oxide use.

Dental Conscious Sedation for the Treatment of Children With Autism Spectrum Disorder: A Narrative Review.

Conscious sedation has been shown to be a reliable behavior management tool that can be used during dental treatments in children who are less cooperative with dental treatment. The purpose of this study is to review the currently available research on the use of conscious sedation during dental procedures for children diagnosed with autism spectrum disorder (ASD). A web-based search for published articles was conducted. Different electronic databases were searched, including PubMed, Google Scholar, Online Review, and the Cochrane Library database, for papers published until February 2023. Studies providing descriptive protocols for dental conscious sedation for children with ASD were included. The search strategy found two studies that met the included criteria. The use of nitrous oxide in conjunction with oral benzodiazepines was found to be effective in sedating children with ASD. This review highlights the lack of research on sedation techniques for children with ASD. Future studies are needed to determine the specific types of sedative medications, their combinations and dosages, and the best methods for conscious sedation during dental procedures for autistic children.

Laughing gas abuse causing subacute combined spinal cord degeneration with psychiatric manifestations

Background. Nitrous oxide, a nonirritating gas commonly used as an anesthetic, is increasingly abused by the young population for its euphoric effects due to its seemingly harmless nature. However, its neurological impacts can vary in intensity and sometimes result in permanent damage. Accurate diagnosis and treatment hinge on identifying nitrous oxide use through anamnesis, clinical and paraclinical findings, as demonstrated in the following case report. Case report. A 27-year-old female with psychiatric history presented with progressive paresthesia and walking difficulty, admitting to recent nitrous oxide use, alongside other substances. Clinical examination revealed mild tetraparesis, coordination disturbances, generalized hyporeflexia, and sensory deficits. Electromyography showed severe sensory neuropathy, and spinal MRI indicated subacute combined degeneration (SCD) of the spinal cord. Laboratory tests revealed hyperhomocysteinemia and elevated methylmalonic acid levels, despite normal vitamin B12 levels. Treatment included intramuscular vitamin B12, folic acid, and neurotrophic agents, along with physical rehabilitation. Psychiatric symptoms, possibly exacerbated by nitrous oxide, and complicated adherence to therapy. Conclusions. This case underscores the neurotoxic potential of nitrous oxide, particularly its disruption of cobalamin metabolism, and highlights the need for thorough patient histories to uncover substance use contributing to neurological symptoms. Despite treatment, some neurological deficits may persist, emphasizing the importance of early intervention and comprehensive care strategies.

Nitrous oxide as a party drug

In recent years, reports of health problems associated with nitrous oxide consumption have significantly increased. In Germany, nitrous oxide (N2O) is easily available in cartridges without legal restrictions. The main reason for its popularity in the party scene are the euphoric, psychedelic effects of the gas. In addition to severe and sometimes irreversible health problems associated with long-term use of nitrous oxide, e.g., anemia and nerve damage, life-threatening or fatal consequences of acute nitrous oxide consumption can also occur: accidents under the influence of nitrous oxide, pneumothorax, pneumopericardium and shock due to an explosive increase in airway pressure when inhaled directly from the cartridge. But the most common cause of severe complications is asphyxia as the gas is usually inhaled pure from large balloons and without oxygen. The resulting hypoxia during use may be perpetuated by the diffusion hypoxia that occurs during the reoxygenation period. Nitrous oxide as acause in accidental or intoxication events is usually not detectable but can only be identified as atrigger based on the patient's history or the circumstances. Acute medical treatment is symptomatic.

(108) ENHANCING PELVIC EXAM COMFORT AND DIAGNOSTIC ACCURACY: REVIEWING THE UTILITY OF NITROUS OXIDE FOR HYPERTONIC PELVIC FLOOR ASSESSMENT

Abstract Introduction Nitrous oxide is an anesthetic, anxiolytic, and analgesic commonly used for general and dental anesthesia, sedation, and severe pain. Studies show that nitrous oxide is also used in several in-office gynecological and urological procedures as a sedative and anxiolytic agent with a safer drug profile than other anesthetic agents. It is also being trialed as a treatment for mood disorders. Nitrous oxide does not render individuals unconscious, making it a more favorable option for stressful and painful medical procedures than general anesthesia because it allows the patient to feel more in control of their body and aware of the proceedings. Objective To analyze the use of in-office nitrous oxide during medical procedures and evaluate its effectiveness in reducing pain and anxiety levels to predict the utility of it during pelvic exams in patients with vestibulodynia. Methods A literature review was performed through the PubMed database between 2007-2022. The authors independently and thoroughly screened abstracts and full-text articles and assessed the relevant medical literature that acknowledged the use of nitrous oxide in in-office medical procedures. Key terms used to refine the search include [“nitrous oxide in medical procedures”], [“nitrous oxide in gynecology”], [“nitrous oxide in urology”]. Results One study explored the use of nitrous oxide during childbirth in women diagnosed with PTSD, and the results were significant for nitrous oxide reducing PTSD symptom severity. Multiple studies suggest the use of nitrous oxide during dental procedures reduces patient anxiety; one specifically measured sixty anxious patients pre- and post-endodontic procedures and noted a significant reduction in anxiety during the procedure with the use of nitrous oxide. Various studies of gynecological and urological procedures report the successful use of nitrous oxide in reducing peri-procedural pain compared to other analgesic alternatives. A common example is its use during intrauterine device insertion, which is correlated with higher patient satisfaction as it decreases pain. Additionally, a study among patients undergoing extracorporeal shockwave lithotripsy found no significant difference between the use of meperidine, an opioid, and nitrous oxide in post-procedural Visual Analog Scale pain scores with no adverse events reported in the nitrous oxide group. Another study revealed that using local anesthesia in transrectal prostate biopsies resulted in some patients experiencing notable anxiety and pain. At the same time, no such relationship was observed among patients who received nitrous oxide before this procedure. Conclusions Vestibulodynia is a subset of genitopelvic pain isolated to the vulvar vestibule. Vestibulodynia has three proposed etiologies: tissue neural proliferation, musculoskeletal, and hormonally mediated. Discriminating these three etiologies can be difficult, especially when a proper pelvic exam cannot be achieved due to patients’ discomfort. The three etiologies are biologically intertwined, often resulting in vestibulodynia patients experiencing pelvic floor hypertonicity without regard to specific etiology. A painful pelvic exam is stressful and often an anxiety-producing experience for patients with pelvic hypertonicity and vulvodynia. Hence, with the data provided, we suspect that nitrous oxide will be a useful treatment option to mitigate these consequences for the patient, with the added benefit of easing the exam for the provider, leading to a more accurate diagnosis. Disclosure No.

Clinical signs of nitrous oxide use: case report and review of the literature

Nitrous oxide is used medically as an anesthetic agent; in the food industry as a propellant for condiments; and recreationally for its euphoric and dissociative effects. We report three cases of nitrous oxide misuse causing severe, symptomatic cobalamin (vitamin B12) deficiency in which signs of nitrous oxide use per se, as well as signs of toxicity, were observed, including characteristic palmar calluses over the metacarpal heads, and frostbite. These signs may assist clinicians in the recognition of nitrous oxide use and the timely diagnosis of nitrous oxide toxicity.

A study of the relationship between Bispectral index and age-adjusted minimum alveolar concentration during the maintenance phase of general anesthesia in elective surgery

Abstract Background and Aims: Bispectral index (BIS) and minimum alveolar concentration (MAC) are commonly used to monitor the depth of anesthesia. The objective was to study the correlation between BIS and age-adjusted minimum alveolar concentration (aaMAC) during the maintenance phase of anesthesia. The influence of variables affecting BIS and or aaMAC was studied to determine an equation between BIS and aaMAC. Material and Methods: This prospective observational study was carried out after institutional ethical approval in adult patients 18–60 years of either sex, ASA I and II posted for elective surgery under general anesthesia. Five minutes after airway management, BIS values and aaMAC equivalents were noted during the maintenance phase of anesthesia. aaMAC and corresponding BIS values were recorded every minute for periods, where the anesthetic agent concentration had remained the same during preceding 5 minutes till the switching off of the anesthetic agent. Age, sex, ASA status, use of nitrous oxide, inhalational agent, dose of midazolam, and opioid used were also recorded. Results: BIS/aaMAC showed an inverse correlation. Increasing age, ASA II status, morphine equivalent &gt;5, and use of nitrous oxide, sevoflurane, or isoflurane were associated with a higher BIS at equivalent aaMAC. Using the exchangeable correlation structure, a generalized estimation equation was obtained as the best predictor. Conclusion: Factors affecting both aaMAC and BIS affect the relationship between the two, and although there are wide variations, BIS and aaMAC can be equated and values of either can be calculated if one is known using a generalized estimates equation.

Longitudinal follow-up and prognostic factors in nitrous oxide-induced neuropathy.

Recreational use of nitrous oxide (N2O) has been associated with the development of severe nitrous oxide-induced neuropathy (N2On). Follow-up of these patients poses challenges, and their clinical progression remains largely unknown. The identification of prognostic factors is made difficult by the lack of standardized longitudinal assessments in most studies. The objective was to document the course of neuropathy through systematic follow-up assessments in N2On patients to identify prognostic factors for persistent disability after 6 months. We gathered demographic, clinical, biological, and electrophysiological data from N2On patients hospitalized in the Referral center in Marseille, both at baseline and during a standardized follow-up assessment at 6 months. We retrospectively included 26 N2On patients (mean age 22.6 ± 4.4). Significant improvements were observed in all main clinical scores including Rankin, ONLS, and MRC testing (p < .01). Electrophysiological studies (EDX) revealed a predominantly motor neuropathy with marked reduction in CMAP in the lower limbs at baseline, and no significant improvement in motor parameters (p = .543). Rankin score at 6 months correlated with the initial weekly N2O consumption (r = .43, p = .03) and the CMAP sum score in the lower limbs at the first EDX (r = -.47, p = .02). Patients with and without myelitis showed similar Rankin and ONLS score after 6 months. The clinical course generally improved favorably at 6 months with notable amelioration in the primary disability scores, sensory deficits, and ataxia. However, distal motor impairment associated with peripheral neuropathy persisted, with distal axonal loss emerging as the main prognostic factor for long-term disability in these young patients.

Perspectives on sustainable practices in the use of nitrous oxide for labour analgesia: A patient and staff survey.

Climate change has emerged as the single biggest global health threat of the twenty-first century. Nitrous oxide accounts for the largest carbon footprint amongst our use of anaesthetic gas. It is a potent greenhouse gas possessing a global warming potential of approximately 265 times that of carbon dioxide. Despite recent curtailment of its use, it remains extensively employed as an analgesic for women in labour. Assessment of the opinions of post-natal women and staff on nitrous oxide use and to investigate whether knowledge of its environmental harm would influence their choice of labour analgesia. Postnatal women and healthcare staff were invited to participate in a survey of nitrous oxide use as a labour analgesic and knowledge of its effect of the environment. A single-centre study in a major obstetric tertiary referral centre in Ireland in 2021. To evaluate the awareness and perceptions of postnatal women and staff regarding the environmental impact of nitrous oxide and if it would affect their decision to use it in the future. One hundred postnatal women and 50 healthcare staff completed the survey. One hundred and six post-natal women were invited to complete the survey, resulting in a response rate of 94%. Knowledge of nitrous oxide's environmental impact was low. After receiving information, 46% of patients were more inclined to seek epidural or request it earlier (54%) to limit their nitrous oxide use, while 51% would choose an alternative analgesia to avoid nitrous oxide altogether. Overwhelmingly, 99% believed they had the right to know about these harmful effects when choosing an analgesic option. Patients should be informed of the environmental impact of nitrous oxide antenatally, empowering them to make informed decision on a climate friendly analgesic option if they wish.

Nitrous Oxide Use for Pain in Labor, Conversion to Neuraxial Analgesia, and Birth Outcome.

A variety of labor pain management options is essential to patients and their care providers. Inhaled, patient controlled nitrous oxide (N2O) is a valuable addition to these options. The purpose of this study was to examine laboring patient, newborn, and provider characteristics associated with N2O use for pain relief in labor and to examine the association between N2O, conversion to neuraxial analgesia, and cesarean birth. This was a retrospective observational cohort study of the first year of N2O use in one large academic medical center. Patients at least 37 weeks' gestation who were admitted for labor with intended vaginal birth from August 1, 2018, to June 30, 2019, were included (N = 2605). Laboring patient and newborn factors and their relationship to N2O use were calculated as unadjusted and adjusted relative risks (RRs). Poisson regression was used to model the association between N2O use and subsequent use of neuraxial analgesia and type of birth for both nulliparous and multiparous patients. Overall, 20.2% of patients used N2O during labor. Multiparous patients were 24% less likely to use N2O than nulliparous patients (RR, 0.76; 95% CI, 0.69-0.84). Use of N2O did not differ significantly between patients cared for by midwives compared with patients cared for by physicians (RR, 0.95; 95% CI, 0.90-1.00). In multivariable modeling, N2O use in multiparous patients was associated with a 17% decrease in use of neuraxial analgesia (RR, 0.83; 95% CI, 0.73-0.94). There was no association between N2O use and use of neuraxial analgesia in nulliparous patients (RR, 0.99; 95% CI, 0.93-1.06). N2O use was not associated with cesarean birth in either group. N2O is an important pain management option for laboring patients and those who care for them. Study results may assist midwives, physicians, and nurses in counseling patients about analgesia options.

More than just joy: A qualitative analysis of participant experiences during nitrous oxide sedation.

Nitrous oxide use is shifting from general anesthesia to sedation and pain control. Interest in novel uses of nitrous oxide in psychiatry is also growing. Thus, understanding the consequences of using nitrous oxide remains relevant. Previous quantitative research might not have fully captured the whole spectrum of nitrous oxide, whereas qualitative analysis can provide a more comprehensive description. This qualitative study aims to describe the subjective experiences of nitrous oxide use in healthy volunteers who have no prior history of recreational substance misuse. Twenty healthy male volunteers inhaled 50% nitrous oxide for 20 min. Females were excluded due to higher incidence of nausea with nitrous oxide. Afterwards, all participants answered an open-ended question about their experiences during sedation. The answers were then analyzed with inductive qualitative content analysis to identify emergent subcategories, categories, and overarching themes. We identified two themes: nitrous oxide is mind-altering and produces sensory overload. The mind-altering properties were represented by dreamlike states and heightened emotions. Dreamlike states comprised changes in consciousness and scary, bizarre, or transcendental dreams. Pleasant dreams were not reported. Heightened emotions included euphoria, anxiety, and fear of losing control. Sensory overload consists of distorted perception, bodily sensations, and a heightened sense of surroundings. Experiences under nitrous oxide sedation are extremely variable and not always pleasant. These findings can improve our understanding of the likes/dislikes of patients undergoing nitrous oxide sedation. Further qualitative studies should focus on the experiences of other groups, such as children or women in labor.