European Society of Anaesthesiology Task Force on Nitrous Oxide: a narrative review of its role in clinical practice.

2019-02-21

Buhre, Wolfgang

Disma, Nicola

Hendrickx, Jan

DeHert, Stefan

Hollmann, Markus W

Huhn, Ragnar

Jakobsson, Jan

Nagele, Peter

Peyton, Philip J

Vutskits, Laszlo

anaesthesia

analgesia

dental pain

labour analgesia

major depression

nitrous oxide

pain

pharmaco-economics

Journal Article

10.1016/j.bja.2019.01.023

Nitrous oxide (N2O) is one of the oldest drugs still in use in medicine. Despite its superior pharmacokinetic properties, controversy remains over its continued use in clinical practice, reflecting in part significant improvements in the pharmacology of other anaesthetic agents and developing awareness of its shortcomings. This narrative review describes current knowledge regarding the clinical use of N2O based on a systematic and critical analysis of the available scientific literature. The pharmacological properties of N2O are reviewed in detail along with current evidence for the indications and contraindications of this drug in specific settings, both in perioperative care and in procedural sedation. Novel potential applications for N2O for the prevention or treatment of chronic pain and depression are also discussed. In view of the available evidence, we recommend that the supply of N2O in hospitals be maintained while encouraging its economic delivery using modern low flow delivery systems. Future research into its potential novel applications in prevention or treatment of chronic conditions should be pursued to better identify its role place in the developing era of precision medicine.

link

British journal of anaesthesia 2019; 122(5): 587-604

British journal of anaesthesia