Nitrous oxide in pediatric anesthesia: friend or foe?
OBJECTIVE
Nitrous oxide has been used in clinical practice for over 150 years, often for pediatric procedures. Not only are there problems when used in patients with a variety of inborn errors of metabolism, but effects of nitrous oxide on the developing human brain are unknown.


RESULTS
A recent adult human trial found that the use of nitrous oxide was associated with increased adverse outcome. Animal studies in several species have shown that nitrous oxide can be associated with apoptosis in the developing brain. Nitrous oxide can also inhibit major enzymatic pathways and repeated exposure may lead to neurologic damage. Single nucleotide polymorphisms in at least one of these enzymes are common in the population.


CONCLUSIONS
There is a growing body of evidence that supports avoidance of nitrous oxide in both pediatric and adult patients, but the thousands of patients who have been exposed to nitrous oxide without apparent complications would suggest that further studies on long-term side effects and possible neurologic consequences need to be done.
Schmitt
Erica L
EL
Department of Anesthesiology, University of Virginia, Charlottesville, Virginia, USA.
Baum
Victor C
VC
D000758:Anesthesia / Q000009:adverse effects* / Q000379:methods; D018685:Anesthetics, Inhalation / Q000009:adverse effects*; D001921:Brain / Q000187:drug effects / Q000254:growth & development; D006801:Humans; D009609:Nitrous Oxide / Q000009:adverse effects*; D010372:Pediatrics; D020641:Polymorphism, Single Nucleotide / Q000187:drug effects / Q000235:genetics; D011183:Postoperative Complications / Q000139:chemically induced; D012307:Risk Factors; D013514:Surgical Procedures, Operative; D014805:Vitamin B 12 / Q000378:metabolism / Q000502:physiology
D018685:Anesthetics, Inhalation; D009609:Nitrous Oxide; D014805:Vitamin B 12