Drug reference
Maintenance of anaesthesia in conjunction with other anaesthetic agents ▶BY INHALATION ▶Adult: 50–66 %, to be administered using suitable anaesthetic apparatus in oxygen Analgesia ▶BY INHALATION ▶Adult: Up to 50 %, to be administered using suitable anaesthetic apparatus in oxygen, adjusted according to the patient’s needs
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Entrapped air following recent underwater dive . pneumothorax. presence of intracranial air after head injury. recent intra-ocular gas injection CAUTIONS, FURTHER INFORMATION Nitrous oxide may have a deleterious effect if used in patients with an air- containing closed space since nitrous oxide diffuses into such a space with a resulting increase in pressure. This effect may be dangerous in conditions such as pneumothorax, which may enlarge to compromise respiration, or in the presence of intracranial air after head injury, entrapped air following recent underwater dive, or recent intra-ocular gas injection.
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Nitrous oxide should only be administered by, or under the direct supervision of, personnel experienced in its use, with adequate training in anaesthesia and airway management, and when resuscitation equipment is available.
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→Appendix 1: nitrous oxide
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Abdominal distension. addiction. agranulocytosis. disorientation. dizziness. euphoric mood. megaloblastic anaemia. middle ear damage. myeloneuropathy. nausea. paraesthesia. sedation. subacute combined cord degeneration. tympanic membrane perforation. vomiting SIDE-EFFECTS, FURTHER INFORMATION Exposure of patients to nitrous oxide for prolonged periods, either by continuous or by intermittent administration, may result in megaloblastic anaemia owing to interference with the action of vitamin B12; neurological toxic effects can occur without preceding overt haematological changes. Depression of white cell formation may also occur.
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May depress neonatal respiration if used during delivery.
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Breast-feeding can be resumed as soon as mother has recovered sufficiently from anaesthesia.
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▶Assessment of plasma-vitamin B12 concentration should be considered in those at risk of deficiency, including the elderly, those who have a poor, vegetarian, or vegan diet, and those with a history of anaemia. ▶Nitrous oxide should not be given continuously for longer than 24 hours or more frequently than every 4 days without close supervision and haematological monitoring.
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For analgesia (without loss of consciousness), a mixture of nitrous oxide and oxygen containing 50% of each gas (Entonox ®, Equanox ®) is used. l HANDLING AND STORAGE Exposure of theatre staff to nitrous oxide should be minimised (risk of serious side- effects).
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There can be variation in the licensing of different medicines containing the same drug. Inhalation gas ▶Nitrous oxide (Non-proprietary) Nitrous oxide 1 ml per 1 ml Nitrous oxide cylinders size E | 1800 litre p s Medical Nitrous Oxide cylinders size D | 900 litre p s Medical Nitrous Oxide cylinders size G | 9000 litre p s Nitrous oxide cylinders size F | 3600 litre p s Nitrous oxide cylinders size J | 18000 litre p s Nitrous oxide cylinders size G | 9000 litre p s Medical Nitrous Oxide cylinders size F | 3600 litre p s Nitrous oxide cylinders size D | 900 litre p s Medical Nitrous Oxide cylinders size E | 1800 litre p s eiiii F 1402
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50–66 %, to be administered using suitable
First-line fragment. Read the complete Indications and Dose section above.
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Up to 50 %, to be administered using suitable
First-line fragment. Read the complete Indications and Dose section above.
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