Nitrous Oxide

Aliases: N2O, Entonox 

Indications: Painful conditions       

Contraindications: Significant respiratory compromise suspected abnormal air-filled cavities (e.g., pneumothorax, bowel obstruction, air embolism), pregnancy.

RELATIVE CONTRAINDICATIONS: History of stroke, hypotension, known cardiac conditions, known vitamin B12 deficiency 

Concentrations: 

Inhalation: Blended with oxygen

Dosing

Adult:

Indication Dose Route Note 
-Brief Painful Procedures 
-Analgesia 		Patient will self-administer Inhalation 

Pediatric:

Indication Dose Route Note 
-Brief Painful Procedures 
-Analgesia 		Patient will self-administer Inhalation 
Use Handtevy or Approved Pediatric Reference Guide for Amount to Administer

Precautions: Others in the area may inhale nitrous oxide. 

Adverse/Side Effects: Nausea/Vomiting, respiratory depression, altered mental status. Teratogenic (cancer causing)  

Class: Weak inhalational anesthetic 

Mechanism of Action: Its analgesic mechanism of action is described as opioid in nature and may involve several spinal neuromodulators. The anxiolytic effect is like that of benzodiazepine and may involve gamma aminobutyric (GABA) receptors. The anesthesia mechanism may involve GABA and possibly N-methyl-D-aspartate receptors as well. In general, the effect of nitrous oxide ceases as soon as the inhalation stops, with no residual effect 

Onset of ActionPeak EffectDuration of Action 
RapidRapidBrief, Limited