Pharmacology
Anaesthesia
Regarding nitrous oxide, which of the following statements is CORRECT:
Answer:
Nitrous oxide must not be used in patients with an air-containing closed space, such as pneumothorax, as nitrous oxide diffuses into these spaces with a resulting increase in pressure. Nitrous oxide is used for maintenance of anaesthesia and, in sub-anaesthetic concentrations, for analgesia. Nitrous oxide increases cerebral blood flow and should be avoided in patients with, or at risk of, raised intracranial pressure. For anaesthesia, nitrous oxide is commonly used in a concentration of around 50 - 66% in oxygen in association with other inhalation or intravenous agents. Nitrous oxide cannot be used as the sole anaesthetic agent due to lack of potency, but is useful as part of a combination of drugs since it allows reduction in dosage of other agents.Nitrous Oxide
Pharmacology / Anaesthesia
Last Updated: 4th April 2019
Nitrous oxide is used for maintenance of anaesthesia and, in sub-anaesthetic concentrations, for analgesia.
Uses
For anaesthesia, nitrous oxide is commonly used in a concentration of around 50 - 66% in oxygen in association with other inhalational or intravenous agents. Nitrous oxide cannot be used as the sole anaesthetic agent due to lack of potency, but is useful as part of a combination of drugs since it allows reduction in dosage of other agents.
For analgesic purposes without the induction of anaesthesia, a mixture of nitrous oxide and oxygen containing 50% of each gas (Entonox®, Equanox®) is used. Self-administration using a demand valve is popular in obstetric practice, for changing painful dressings, as an aid to postoperative physiotherapy, and in emergency ambulances.
Contraindications
Nitrous oxide must not be used in patients with an air-containing closed space as nitrous oxide diffuses into these spaces with a resulting increase in pressure. This includes conditions such as pneumothorax, the presence of intracranial air after head injury, entrapped air following recent underwater dive, recent intraocular gas injection or intestinal obstruction. Nitrous oxide also increases cerebral blood flow and should be avoided in patients with, or at risk of, raised intracranial pressure.
Side Effects
Hypoxia can occur immediately following the administration of nitrous oxide; additional oxygen should always be given for several minutes after stopping the flow of nitrous oxide.
Exposure to nitrous oxide for prolonged periods, either by continuous or by intermittent administration, may result in megaloblastic anaemia as a result of interference with the action of vitamin B12; neurological toxic effects can occur without preceding overt haematological changes. Depression of white cell formation may also occur.
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- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
