Acute neurologic decompensation in an infant with cobalamin deficiency exposed to nitrous oxide

Nitrous oxide. Should it still be used in pediatric medicine ? (Part 1)

“…Such neuropathies are thus a major problem in the recreational and less frequently also after anesthesia [102]. Numbness, tingling, ataxia and/or muscle weakness, and impotence are frequently described [103,104]. Animal studies have confirmed these effects [105,106].…”

Nitrous oxide in pediatric anesthesia: friend or foe?

“…B 12 deficiency can result secondary to resection of the terminal ileum, pernicious anemia, or dietary restrictions, most commonly vegan, although it is also possible with protein restrictive diets such as those prescribed for phenylketonuria [14]. Case reports illustrate that B 12 -deficient patients exhibit neurologic and hematologic consequences after as little as 80 min of exposure to nitrous oxide and, as in the above case, the onset of findings can be delayed for weeks [15][16][17]. Of note to pediatric anesthesiologists, there have been two reports of breast-fed infants who developed anemia and/or neuropathy.…”

“…Reprinted with permission from [7 ]. both of these infants were B 12 deficient, from deficiency of intrinsic factor [15] or from a vegan diet [16].…”

Uso do óxido nitroso em pediatria

“…Case reports illustrate that these patients or newborns of mothers with these problems may present hematological and neurological complications after exposure to nitrous oxide 82 (D) 83,84 (C).…”

“…Patients with vitamin B 12 deficiency developed different hematological and neurological manifestations, after intraoperative exposure to nitrous oxide 82 (D) 83,84 (C). Thus, various authors raise the concern about the administration of nitrous oxide to children, given the high prevalence of metabolic defects and vitamin deficiencies in this population.…”