Frostbite injuries to the upper aerodigestive tract sustained from inhaled nitrous oxide

Abstract

Background Nitrous oxide (N2O) has been in industrial and recreational use since the 18th century and is commonly perceived as a safe substance. Despite its increasing uptake, there is a lack of data on N2O-related harm. This article explores the misuse of N2O associated with various complications, with a focus on frostbite as a novel phenomenon. We aimed to review the existing body of literature and describe the epidemiology, presentation, pathophysiology, and management of patients with N2O-related frostbite injuries in the upper aerodigestive tract. Methods A literature search was conducted across PubMed, MEDLINE and Embase databases, focusing on English language articles related to N2O use patterns, associated injuries, pathophysiology, investigations, and management. Results The search yielded 122 results, of which fifteen case reports and case series were included in the study. There are 54 total cases included in the analysis. There is an equal distribution of males and females among a young population with a median age of 27.5 years. Presentations of skin and mucosal injuries across different anatomical sites as well as their management approaches are described. Conclusions The pathophysiology of frostbite involves both direct and indirect effects, leading to tissue ischaemia, inflammation, and immune responses. Complications, including airway obstruction, underscore the severity of N2O-related injuries. Management strategies include securing the airway, surgical debridement, and pharmacological interventions such as prophylactic corticosteroids and antibiotics. N2O is a documented causative agent of frostbite injuries. Awareness of its rising prevalence and potential complications is key in the treatment of patients with complications sustained from the use of N2O. Level of evidence Not ratable