title: Laughing Gas in a Pediatric Emergency Department-Fun for All Participants: Vitamin B12 Status Among Medical Staff Working With Nitrous Oxide.
abstract: The efficiency of nitrous oxide in an equimolar mixture with oxygen or in concentrations up to 70% is approved for short painful procedures. Evaluation of the vitamin B12 levels in anesthetic staff applying nitrous oxide showed reduced vitamin B12 plasma levels. This study examines the vitamin B12 status of medical staff working with nitrous oxide in a pediatric emergency department (ED). Medical staff of the ED at the University Children's Hospital Zurich participated. The vitamin B12 status was evaluated by measuring homocysteine, methylmalonic acid, vitamin B12, blood count, and the MTHFR C677T genotype. As a control group, medical personnel working in the "nitrous oxide-free" pediatric intensive care unit were recruited.
  
  
  RESULTS
  The parameters for the vitamin B12 status of all participants were in the reference range, and there were no significant differences for the 2 groups. By trend, the ED staff showed higher vitamin B12 levels. The ED staff members were slightly older (P = 0.07) and had higher hemoglobin levels (P < 0.04) compared with the pediatric intensive care unit staff.
  
  
  CONCLUSIONS
  The use of nitrous oxide (50%-70%) with a demand valve is safe for the vitamin B12 status of medical personnel in the ED.
authors.affiliation: From the *Department of Emergency Care, †Divisions of Metabolism, ‡Clinical Chemistry and Biochemistry, University Children's Hospital and Children's Research Center, Zurich, Switzerland.
authors.forename: Georg
authors.initials: G
authors.lastname: Staubli
authors.forename: Matthias
authors.initials: M
authors.lastname: Baumgartner
authors.forename: Jörn Oliver
authors.initials: JO
authors.lastname: Sass
authors.forename: Martin
authors.initials: M
authors.lastname: Hersberger
mesh_terms: D000328:Adult; D018685:Anesthetics, Inhalation; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D006710:Homocysteine / Q000097:blood; D006801:Humans; D008297:Male; D008503:Medical Staff; D042965:Methylenetetrahydrofolate Reductase (NADPH2) / Q000235:genetics; D008764:Methylmalonic Acid / Q000097:blood; D009609:Nitrous Oxide / Q000008:administration & dosage* / Q000009:adverse effects; D009784:Occupational Diseases / Q000097:blood / Q000139:chemically induced; D016273:Occupational Exposure / Q000032:analysis* / Q000517:prevention & control; D020641:Polymorphism, Single Nucleotide; D014805:Vitamin B 12 / Q000097:blood*; D014806:Vitamin B 12 Deficiency / Q000097:blood / Q000139:chemically induced
chemical_list: D018685:Anesthetics, Inhalation; D006710:Homocysteine; D008764:Methylmalonic Acid; C573423:MTHFR protein, human; D042965:Methylenetetrahydrofolate Reductase (NADPH2); D009609:Nitrous Oxide; D014805:Vitamin B 12