Initiating Intrapartum Nitrous Oxide in an Academic Hospital: Considerations and Challenges

Migliaccio, Laura; Lawton, Robyn; Leeman, Lawrence; Holbrook, Amanda

doi:10.1111/jmwh.12635

Cited by 9 publications

(4 citation statements)

References 20 publications

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“…Nitrous oxide is a low-potency inhaled anaesthetic with a long history of use for labour, 19 and has a high utilisation rate of 50-75% in many Western countries, 20,21 Nitrous oxide can be self-administered, 16 or overseen by nursing staff, 22 resulting in reduced time consumption and reduced manpower requirement.…”

Section: Discussionmentioning

confidence: 99%

Epidural analgesia use during labour in maternity hospitals across China: A prospective case-control questinnaire survey

Zheng,

Tao,

Shen

et al. 2023

Preprint

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Background Specialised maternity hospitals respond to over 90% of labour analgesia requests in their localities within China. We administered a questionnaire survey to determine the predictors of labour analgesia use in two of these hospitals, with the aim of further enhancing epidural analgesia utilisation during labour. Methods This prospective case-control multi-centre questionnaire survey included a total of 640 postpartum women with 374 women who received epidural analgesia and 266 women who did not receive epidural analgesia. The questionnaire contained 20 questions and was distributed through WeChat from July 2022 to September 2022. The responses to the questionnaires were uploaded to the cloud storage space, and only the statistician had access to the original data. Multivariate logistic regression analysis was used to screen variables related to the receipt of epidural labour analgesia. Binary logistic regression was used to identify predictors related to the administration of epidural labour analgesia from a set of selected variables. Results Binary logistic regression results of the survey data showed that multi-parity (odds ratio [OR] 2.805, 95% confidence interval [CI] 1.792 to 4.393, P < 0.001), late arrival of anaesthesiologist (OR 2.728, 95% CI 1.180–6.306, P = 0.019), and rapid progress in first stage of labour (OR 11.709, 95% CI 7.449–18.404, P < 0.001) prevented women from receiving epidural labour analgesia, while women’s preference (OR 0.035, 95% CI 0.013–0.097, P < 0.001) and family agreement to epidural analgesia prior to labour (OR 0.091, 95% CI 0.016–0.551, P = 0.006) promoted its use. Conclusions To address the factors that may hinder or promote the use of epidural labour analgesia in maternal specialised hospitals, pregnant women should be screened for the risk of rapid progression in the first stage of labour and be provided latent-phase labour analgesia. Moreover, in cases where anaesthesiologists are unavailable or when women have contraindications to epidural analgesia, inhalation nitrous oxide analgesia and intravenous remifentanil analgesia should be considered as alternative options. It is recommended that hospitals provide professional, comprehensive, and free antenatal education on labour analgesia to pregnant women and their families to further promote the use of epidural analgesia. Trial registration: http://www.chictr.org.cn ChiCTR2200055621; January 15, 2022.

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Section: Discussionmentioning

confidence: 99%

Epidural analgesia use during labour in maternity hospitals across China: A prospective case-control questinnaire survey

Zheng,

Tao,

Shen

et al. 2023

Preprint

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“…Beginning to offer this pain management method in a facility requires collaboration among members of the interprofessional health team, which is another hallmark of midwifery. Migliaccio et al describe their process of initiating nitrous oxide in an academic medical center with lessons learned that can help others introduce this option.…”

Section: Hallmarks Of Midwiferymentioning

confidence: 99%

The Hallmarks of Midwifery Connect This Diverse Pharmacology Continuing Education Theme Issue

Likis¹

2017

J Midwife Womens Health

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“…4 However, interest in the use of N 2 O is currently growing in the United States as well. 5 Recent years have seen the use of N 2 O spreading to new areas.…”

Section: Introductionmentioning

confidence: 99%

“…The use of N 2 O in labor varies from 50% to 70% in the United Kingdom to as low as 6% in the United States 4 . However, interest in the use of N 2 O is currently growing in the United States as well 5 …”

Section: Introductionmentioning

confidence: 99%

More than just joy: A qualitative analysis of participant experiences during nitrous oxide sedation

Valtonen,

Markkanen,

Järventausta

et al. 2024

Acta Anaesthesiol Scand

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BackgroundNitrous oxide use is shifting from general anesthesia to sedation and pain control. Interest in novel uses of nitrous oxide in psychiatry is also growing. Thus, understanding the consequences of using nitrous oxide remains relevant. Previous quantitative research might not have fully captured the whole spectrum of nitrous oxide, whereas qualitative analysis can provide a more comprehensive description. This qualitative study aims to describe the subjective experiences of nitrous oxide use in healthy volunteers who have no prior history of recreational substance misuse.MethodsTwenty healthy male volunteers inhaled 50% nitrous oxide for 20 min. Females were excluded due to higher incidence of nausea with nitrous oxide. Afterwards, all participants answered an open‐ended question about their experiences during sedation. The answers were then analyzed with inductive qualitative content analysis to identify emergent subcategories, categories, and overarching themes.ResultsWe identified two themes: nitrous oxide is mind‐altering and produces sensory overload. The mind‐altering properties were represented by dreamlike states and heightened emotions. Dreamlike states comprised changes in consciousness and scary, bizarre, or transcendental dreams. Pleasant dreams were not reported. Heightened emotions included euphoria, anxiety, and fear of losing control. Sensory overload consists of distorted perception, bodily sensations, and a heightened sense of surroundings.ConclusionsExperiences under nitrous oxide sedation are extremely variable and not always pleasant. These findings can improve our understanding of the likes/dislikes of patients undergoing nitrous oxide sedation. Further qualitative studies should focus on the experiences of other groups, such as children or women in labor.

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Initiating Intrapartum Nitrous Oxide in an Academic Hospital: Considerations and Challenges

Cited by 9 publications

References 20 publications

Epidural analgesia use during labour in maternity hospitals across China: A prospective case-control questinnaire survey

Epidural analgesia use during labour in maternity hospitals across China: A prospective case-control questinnaire survey

The Hallmarks of Midwifery Connect This Diverse Pharmacology Continuing Education Theme Issue

More than just joy: A qualitative analysis of participant experiences during nitrous oxide sedation

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