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January 15, 1982

Nitrous Oxide-Oxygen Sedation

JAMA. 1982;247(3):302. doi:10.1001/jama.1982.03320280024006

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To the Editor.—  The use of nitrous oxide-oxygen sedation in a pediatric office described by Griffin et al (1981; 245:2411) includes many important safety precautions, especially the recommendations to use equipment designed for safety and to ensure its proper installation. These measures will help protect the patient; however, there was no mention of risks to the emergency room staff from long-term exposure to nitrous oxide. With delivery rates of up to 6 L/min discharged into a treatment room, even with the recommended six air changes per hour, atmospheric pollution by nitrous oxide reaches high levels.A sample calculation for a typical emergency room, with six air changes per hour and a procedure involving 3 L/min of nitrous oxide flow for four minutes' induction followed by a 20-minute procedure, resulted in a calculated nitrous oxide concentration of 780 ppm. This is more than 30 times the National Institute of Occupational Safety