Biologic effects of nitrous oxide: a mechanistic and toxicologic review.
Nitrous oxide is the longest serving member of the anesthesiologist's pharmacologic armamentarium but remains a source of controversy because of fears over its adverse effects. Recently, the Evaluation of Nitrous oxide In a Gas Mixture for Anaesthesia (ENIGMA) trial reported that nitrous oxide use increases postoperative complications; further preclinical reports have suggested that nitrous oxide may contribute to neurocognitive dysfunction in the young and elderly. Therefore, nitrous oxide's longevity in anesthetic practice is under threat. In this article, the authors discuss the evidence for the putative toxicity of nitrous oxide, from either patient or occupational exposure, within the context of the mechanism of nitrous oxide's action. Although it would seem prudent to avoid nitrous oxide in certain vulnerable populations, current evidence in support of a more widespread prescription from clinical practice is unconvincing.
Sanders
Robert D
RD
Department of Anaesthetics, Pain Medicine, and Intensive Care, Imperial College London, Chelsea and Westminster Hospital, London, United Kingdom.
Weimann
Jörg
J
Maze
Mervyn
M
D013766:5-Methyltetrahydrofolate-Homocysteine S-Methyltransferase / Q000037:antagonists & inhibitors; D000700:Analgesics / Q000494:pharmacology; D000701:Analgesics, Opioid / Q000494:pharmacology; D018685:Anesthetics, Inhalation / Q000633:toxicity*; D000818:Animals; D002986:Clinical Trials as Topic; D006801:Humans; D007107:Immune System / Q000187:drug effects; D042965:Methylenetetrahydrofolate Reductase (NADPH2) / Q000235:genetics; D009420:Nervous System / Q000187:drug effects; D009609:Nitrous Oxide / Q000494:pharmacology / Q000633:toxicity*; D016273:Occupational Exposure / Q000009:adverse effects; D016194:Receptors, N-Methyl-D-Aspartate / Q000037:antagonists & inhibitors; D012098:Reproduction / Q000187:drug effects; D012107:Research Design
D000700:Analgesics; D000701:Analgesics, Opioid; D018685:Anesthetics, Inhalation; D016194:Receptors, N-Methyl-D-Aspartate; D042965:Methylenetetrahydrofolate Reductase (NADPH2); D013766:5-Methyltetrahydrofolate-Homocysteine S-Methyltransferase; D009609:Nitrous Oxide