Nitrous oxide

Nitrous oxide (laughing gas) is a slow-acting gas with good analgesic and limited anesthetic effects, so it must be combined with other anesthetics and/or muscle relaxants to obtain complete anesthesia. It is more often used in dentistry for analgesia and partial anesthesia.

Compared to halogenated inhalation anesthetics, nitrous oxide is a well-tolerated anesthetic with no negative effects on the circulatory system or on the uterus. By inhalation of a nitrous oxide-oxygen mixture during labor, the quickest and most simple analgesic effect can be achieved, which can be controlled very well. In rare cases, nitrous oxide can be associated with neonatal respiratory depression requiring resuscitation (Langanke 1987).

There are several epidemiologic studies in pregnant women (altogether over 1000 exposures) administered nitrous oxide during pregnancy, reporting that its use during pregnancy has not been associated with an increase in congenital malformations (Crawford 1986, Heinonen 1977). On the other hand, there are studies demonstrating several deleterious effects on the newborn infant following the use of nitrous oxide during delivery. Taylor (1993) found a higher use of nitrous oxide during delivery in children with developmental delay, and Polvi (1996) found alterations in fetal cerebral vascular resistance. These studies have been criticized, as there are possible confounding factors that are not well-delineated. Occupational exposure to nitrous oxide has been associated with an increased rate of spontaneous abortions and reduced fertility whenever scavenging devices for the reduction in nitrous oxide concentrations have not been used (Rowland 1995, 1992). Animal studies have demonstrated an increase in the rate of congenital anomalies, resorptions, decreased growth, and behavioral changes in rats (Rice 1994, Rodier 1986) but not in hamsters. These studies, however, usually use prolonged exposure to high doses, and their relevance to man is questionable.

Recommendation. Nitrous oxide is an acceptable inhalation agent for use during pregnancy and labor. When used during labor, the newborn should be evaluated for respiratory depression.

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