Just Steve Posted July 30, 2012 Share Posted July 30, 2012 I can't say I have worked in a lot of ERs, but as a paramedic, I have hung out in A LOT. I don't recall ever seeing anyone use Nitrous oxide. When I think of closed reductions, suturing of pediatrics, perhaps even more invasive procedures where we just want the edge off, to help them relax a bit, but plan to send them home after the procedure, why don't we use NOX instead of things such as Midazolam or Ativan? I am just a student, so I have a lot to learn still. I just had some dental work done, my comfort aided by the administration of NOX and it was great. Took the edge off, I kept my mental clarity, back to 100% functioning within minutes, easy to titrate... Can someone fill me in please? What am I missing? Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted July 30, 2012 Moderator Share Posted July 30, 2012 Because it has gotten a bad rep. Diffusion hypoxia, inhibition of methione synthetase causing anemia, constantly blamed for nausea (though no good evidence to support IMO), on and on. Many anesthesia personnel abhor it's use, while others think it's one of the best anesthesia adjuncts we have. I'm in the latter camp. Recently, some hospitals have gone BACK to using it with pregnant women to help with labor pain instead of epidurals. Also a new study has come out extolling it's use that you can read HERE. Some anesthetist still want to deny it's use though because mostly they are afraid of diffusion hypoxia and post-op nausea. Diffusion hypoxia is a non-issue if you give O2 afterwards and I've already given my opinion on post op nausea by nitrous. IME, it is great. Used it at 50% nitrous, 1.5% sevo (rest being 02 of course) during a surgery and at 70% nitrous and 30% O2 at the end of a case since it would come off faster than volatile agent. Worked like a charm. Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted July 30, 2012 Moderator Share Posted July 30, 2012 A good analogy would be droperidol. Great drug that just got bad publicity. Link to comment Share on other sites More sharing options...
flyingsquirrel Posted July 31, 2012 Share Posted July 31, 2012 Nitrous is used prehospitally in Europe (and Australia I think) by both Paramedic and EMT-level providers. I've heard rumors of a few services in the US that use it, but I've never actually talked to anyone who has worked in them. I think that one of the main barriers is infrastructure. I worked in a children's hospital that was built about 20 years ago. We obviously have O2, medical air, and suction ports in all the rooms, but if we wanted nitrous we had to go up to the OR and lug the entire tank down to wherever we wanted to sedate a kid. It was much faster to just put in an IV and give opiates/benzos for a standard conscious sedation. (Of course it took much longer for them to come out of it too.) I was talking to the pedi ED director one day and he said that if he ever got a chance to renovate the ED, he would put nitrous ports in all the rooms in the ED. Interestingly, I had to have some testing done a couple of months ago and ended up in the pre-op area of the hospital that my PA school is affiliated with. As I was waiting, I noticed that they did have nitrous ports along with the standard O2, medical air, and suction. Maybe there is hope after all. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 31, 2012 Moderator Share Posted July 31, 2012 $$$$ our medics have it and we don't.... Link to comment Share on other sites More sharing options...
Moderator ventana Posted July 31, 2012 Moderator Share Posted July 31, 2012 I had the unfortunate experience of having to get nitrous from a medic after a t-9 burst fracture - he was nice enought to tell me to suck a lot down before getting transfered in to the ER "cause they don't have any of this in there and it will be hours before you get any pain control" Thankfully it was only about 5-10 minutes till the oral pain meds (gotta love the USAF!) Nitrous seemed to work great but i never got laughing..... Link to comment Share on other sites More sharing options...
fuma102 Posted August 4, 2012 Share Posted August 4, 2012 Ketamine works wonders in peds provided you dont have a noisy environment causing them to freak (then you just give versed and they wake up normal)... or for adults, propofol is where its at. I find for joint reductions they patients tend to fight a bit with versed/fentanyl and it takes longer to snap out of it. Link to comment Share on other sites More sharing options...
rcdavis Posted August 11, 2012 Share Posted August 11, 2012 Best reason I've found is that you cannot keep the nurses and attendings out of the stuff Link to comment Share on other sites More sharing options...
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