Nitrous oxide and cervical myelopathy

Ng, Gee Jin; Chiew, Yi Rong

doi:10.47102/annals-acadmedsg.2021430

Cited by 5 publications

(2 citation statements)

References 12 publications

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“…For its administration, it is necessary to ask the patient's medical history to know if he/she has cardiovascular diseases, since the gas can increase the heart rate and respiratory frequency, increasing the oxygen demand of the heart. If the patient is allergic to the gas administered, there may be skin rashes accompanied by urticaria, as well as difficulty breathing, coughing or wheezing, a possible sign of bronchospasm or inflammation of the airways [33] . The patient may present with swelling of the face, tongue or throat [34] .…”

Section: Disadvantagesmentioning

confidence: 99%

Sedation in pediatric dentistry: A scoping review

Salinas,

Cepeda,

Capetillo

et al. 2024

Int. J. Appl. Dent. Sci.

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Introduction: Pediatric dentists face the daily challenge of treating patients with anxiety, phobias and fears, and it is important to know the drugs for each patient. Objective: To analyze the literature on drugs used for sedation, particularly dexmedetomidine, ketamine, midazolam and nitrous oxide. Methodology: Articles were searched in databases such as PubMed, Google Scholar, using keywords: sedation, drugs, pediatric dentist, pediatric patient. Results: Dexmedetomidine provides sedation, analgesia and sympathicolysis, is safe and acceptable in infants and children without respiratory depression, and adverse events such as hypoxemia and bradycardia may occur. Ketamine is a drug that presents multiple routes of administration and has analgesic, hypnotic, amnesic, anti-inflammatory and sympathomimetic properties, having undesirable side effects such as delirium, psychosis, perception disorders, arterial and intraocular hypertension. Midazolam is a fast-acting and short-acting drug, which can be administered by different routes. It presents adverse reactions such as disinhibition, hallucinations and marked respiratory depression. Oral absorption and action time are prolonged. Nitrous oxide has analgesic and anesthetic effect, as well as its rapid elimination from the body, does not affect respiration, so it is possible to administer it in patients with respiratory ailments, its use is limited to short or non-invasive procedures and can cause side effects such as nausea, vomiting, headache and fatigue. Conclusion: All the drugs reviewed have unacceptable systemic side effects, and if it is necessary to choose one, it would be nitrous oxide as the best drug to use for sedation in pediatric dentistry.

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Section: Disadvantagesmentioning

confidence: 99%

Sedation in pediatric dentistry: A scoping review

Salinas,

Cepeda,

Capetillo

et al. 2024

Int. J. Appl. Dent. Sci.

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“…We identified 154 patients meeting our inclusion criteria after reviewing the literature 5–68 . There was a predominance of males (n=94, 61%), and the median age was 22 [19 to 26] years.…”

Section: Case Seriesmentioning

confidence: 99%

Neurological Manifestations Induced by Nitrous Oxide Abuse

Pichon,

Majhadi,

Menn

2023

The Neurologist

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Introduction: Nitrous oxide (NO) abuse is increasing among young people. This can result in severe neurological disorders such as myelopathy and/or peripheral neuropathy. We report the clinical presentations, biological, radiologic and electrophysiological findings of 5 patients hospitalized with neurological symptoms consecutive to NO abuse. In addition, a literature review was conducted to describe the neurological characteristics and to identify factors associated with a poor recovery. Case report: Among the 5 patients included, 2 had a myeloneuropathy, 2 had a sensorimotor neuropathy, and 1 had a normal spinal cord magnetic resonance imaging and electromyography despite neurological manifestations consistent with myeloneuropathy. After vitamin B12 supplementation, recovery was reported in 4 patients, and 1 was lost to follow-up. From the literature review, 154 patients were included [94 males; median age 22 (19 to 26) y; NO exposure 9 (3 to 18) mo]. A myelopathy was identified in 116 patients (75%) and a peripheral neuropathy was documented in 89 patients (58%). Compared with patients who recovered, those with sequelae were more likely to have a motor deficit at presentation (P<0.001), to use NO regularly (P<0.001), to have a lower vitamin B12 level (P=0.04), and a higher concentration of homocysteine (P=0.04). A less extensive myelopathy was more frequently found in the group with favorable outcomes (P=0.002). Conclusion: Neurological disorders caused by NO may be challenging with severe clinical patterns. We identified several factors associated with a poor recovery, to make clinicians aware of NO-induced neurotoxicity.

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The boon and bane of nitrous oxide

Kronenberg,

Schoretsanitis,

Seifritz

et al. 2024

Eur Arch Psychiatry Clin Neurosci

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Nitrous oxide (N2O) has been known since the end of the eighteenth century. Today, N2O plays a huge role as a greenhouse gas and an ozone-depleting stratospheric molecule. The main sources of anthropogenic N2O emissions are agriculture, fuel combustion, wastewater treatment, and various industrial processes. By contrast, the contribution of medical N2O to the greenhouse effect appears to be small. The recreational and medical uses of N2O gradually diverged over time. N2O has analgesic and anesthetic effects, making it widely used in modern dentistry and surgery. New research has also begun studying N2O’s antidepressant actions. N-methyl-D-aspartate (NMDA) antagonism and opioid effects are believed to be the main underlying biochemical mechanisms. At this point, numerous questions remain open and, in particular, the conduct of larger clinical trials will be essential to confirm N2O’s use as a rapid-acting antidepressant. The N2O concentration delivered, the duration of a single inhalation, as well as the number of inhalations ultimately required, deserve to be better understood. Finally, the non-medical use of N2O has gained significant attention in recent years. Sudden deaths directly attributed to N2O are primarily due to asphyxia. Heavy, chronic N2O use may result in vitamin B12 deficiency, which, among other things, may cause megaloblastic anemia, venous thrombosis, myeloneuropathy, and skin pigmentation. Helpful biochemical tests include homocysteine and methylmalonic acid. The centerpiece of treatment is complete cessation of N2O use together with parenteral administration of vitamin B12.

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Nitrous oxide and cervical myelopathy

Cited by 5 publications

References 12 publications

Sedation in pediatric dentistry: A scoping review

Sedation in pediatric dentistry: A scoping review

Neurological Manifestations Induced by Nitrous Oxide Abuse

The boon and bane of nitrous oxide

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