title: Nitrous oxide in ambulatory anaesthesia: does it have a place in day surgical anaesthesia or is it just a threat for personnel and the global environment?
abstract: OBJECTIVE
  Nitrous oxide is by far the oldest anaesthetic still in routine use and its continued use is often questioned. Nitrous oxide is toxic with prolonged exposure, can damage the environment, causes pressure effects through expansion of closed air-filled spaces and has long been suspected of being harmful following chronic exposure to trace concentrations. What could possibly justify the continuing use of nitrous oxide?
  
  
  RESULTS
  This review will attempt to demonstrate that the harmful effects of nitrous oxide are limited and not relevant to the majority of ambulatory patients. The environmental effects of nitrous oxide derived from anaesthetic use are negligible and there is no convincing evidence of harm to personnel.
  
  
  CONCLUSIONS
  Not only is nitrous oxide almost certainly less hazardous than is sometimes perceived, it has numerous benefits which are not easily replicated by possible alternatives. In particular, its use improves the quality and safety of induction and maintenance of anaesthesia and facilitates faster recovery with minimal adverse effects. All of these benefits are achieved while at the same time reducing overall costs. With few significant drawbacks and numerous advantages, there appears still to be a valuable place for nitrous oxide in modern ambulatory anaesthesia.
authors.affiliation: University Hospital of North Staffordshire, Stoke-on-Trent, Staffordshire, UK. damsmith@btinternet.com
authors.forename: Ian
authors.initials: I
authors.lastname: Smith
mesh_terms: D000395:Air Pollutants, Occupational / Q000009:adverse effects*; D000556:Ambulatory Surgical Procedures; D000762:Anesthesia Recovery Period; D018685:Anesthetics, Inhalation / Q000009:adverse effects*; D004787:Environmental Pollution; D006282:Health Personnel; D006801:Humans; D009609:Nitrous Oxide / Q000009:adverse effects*; D010880:Piperidines / Q000627:therapeutic use; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced; D000077208:Remifentanil; D018570:Risk Assessment; D014978:Xenon / Q000627:therapeutic use
chemical_list: D000395:Air Pollutants, Occupational; D018685:Anesthetics, Inhalation; D010880:Piperidines; D014978:Xenon; D009609:Nitrous Oxide; D000077208:Remifentanil