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August 22, 1980

Nitrous Oxide Analgesia

Author Affiliations

Wilmington Medical Center Wilmington, Del

JAMA. 1980;244(8):769. doi:10.1001/jama.1980.03310080011009

To the Editor.—  The report by Thal et al (242:2418, 1979) on the use of an oxygen-nitrous oxide mixture to provide analgesia for patients during emergency transport on mobile intensive care units is interesting but raises some concerns.One consideration is the exposure of mobile unit personnel to the exhaled nitrous oxide (N2O). It is likely that high levels of N2O may accumulate within the confined space of a mobile unit. Long-term exposure of transport personnel may affect their performance1 as well as longterm safety. If N2O use continues, proper scavenging should be imple mented.In addition, although the side effects and contraindications to using N2O were noted, it should be reemphasized that this is not a benign drug. In critically ill patients, it may obtund reflexes. Furthermore, N2O may affect the cardiovascular system by reducing cardiac output and increasing