O2 and N2O: Between the Rock and the Hard Place

Abstract

The use of oxygen and nitrous oxide is part of anesthetic practice since ever. These gases follow anesthetic practice in almost all types of clinical settings, procedures and patients. Their indications and limitations of use are well known.In recent years a great debate either in literature or in scientific meetings has been addressed, concerning the potential poor outcomes related to the use of certain amounts of oxygen and the use of nitrous oxide.The objective of this review is to gather information related to these two topics, based on the recent most relevant publications (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016).Results show that both drugs have its advantages and drawbacks, and it is the clinical objective, the procedure, and the type of patient that will contribute the most for the anesthesiologist final decision.As a conclusion it was found that, 1) oxygen is a lifesaving drug on one side, but its use should be judicious since its high inspired fraction may have direct implications on that lung wellbeing, and 2) nitrous oxide has its known contraindications that should be taken into consideration and preclude its use when not clinically appropriate, however no evidence exists that indicates a formal discontinuation of its use, and in certain clinical scenarios it can be of relevant utility.