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February 24, 1984

Nitrous Oxide Analgesia-Reply

JAMA. 1984;251(8):1028. doi:10.1001/jama.1984.03340320018015

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In Reply.—  This letter raises several points that deserve further elaboration. There is no doubt that patients who have undergone treatment for cancer have a variety of complex medical problems, including myocardial dysfunction. In our opinion, once it has been established that a patient in severe pain is near death, treatment of pain becomes the overriding issue despite any concurrent medical problems. The approach to pain control will vary depending on circumstances, and it is clear that any intervention, including epidural analgesia or anesthesia as well as nitrous oxide, will have potential complications.We have proposed that nitrous oxide analgesia is one way of treating intractable pain that deserves consideration. In our experience, cardiovascular side effects were not obvious and patients' moods and level of consciousness improved rather than diminished. Since our end point is patient comfort rather than physiological stability, we believe that repeated assessment of vital signs is