Anesthesia

CNS -  amnesia, ( concentration dependent )

Hematologic - agranulocytosis, megaloblastic changes

Respiratory - mild respiratory depression

Miscellaneous- cases of subacute combined degeneration of the spinal cord precipated
by nitrous oxide have been reported

Nitrous oxide is contraindicated during tympanopathy because increased pressure caused
by nitrous oxide can dislodge  a typhanic graft

Special precautions-

Bowel distention and or ischemia-  nitrous is best avoided in situations in which bowel is disteneded

Cardiovascular reactions- nitrous may increase pulmonary vascular resistence, especially in
patients with preexisting pulmonary hypertension. In patients with mild cardiovascular reserve,
these reactions may not be well tolerated

Cerebrovascular reactions- consider avoiding or discontinuing the use of nitrous oxide in patients
with likelihood of elevated ICP or significant cerbral ischema

Hypoxia/hypoexmia- supplemental oxygen is required to prevent hypoxia and hypoxemia when
nitrous oxide is discontinued

Expansion of closed gas spaces- gas containing spaces ( pneumothroax, occlude middle ear,
boweel lumen, pneumocephalus ) may excessively expand when nitrous is asministered.
Assess this pressure intermittently and adjust thepressure as indicated.  

Hematologic reactions- megaloblastic changes have been seen in patients exposed to nitrous
oxide for 24 hours and agranulocytosis  has been reported in patients exposed to nitrous oxide
for 4 days.

Pregnancy- It is safest to postpone elective surgeries until after the pregnancy or until at least
after organogenesis period.

Lactation-  No published reports describing the use of nitrous oxide during breast feeding .
nitrous oxide is considered to be compatible with breast feeding.

Children-  nitrous oxide appears to a reasonable drug for use in neonates as  long as thrre is
no concern for expanding gas spaces ( intestinal obstruction, pneumocephalus )

Indication-
Anesthesia

Dosage-
The concentration and administration rate of nitrous oxide ( given with oxygen ) are patient and
usage-specific.
Concentration as low as 20% will usually produce analgesia, and concentration between 30%
to 80% will usually produce sedation
Do not give concentration above 80% because nitrous oxide will limit the delivery of adequate
amount of oxygen

Pregnancy-
 It is safest to postpone elective surgeries until after the pregnancy or until at least
after organogenesis period.

Lactation- 
No published reports describing the use of nitrous oxide during breast feeding .
nitrous oxide is considered to be compatible with breast feeding.

Children- 
Nitrous oxide appears to a reasonable drug for use in neonates as  long as there is
no concern for expanding gas spaces ( intestinal obstruction, pneumocephalus )