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Even with the accumulated knowledge gained from several years' experience in the prolonged administration of nitrous oxid (and oxygen), there is still quite a tendency by some to disregard essential elements of safety, especially when nitrous oxid, administered with normal oxygenation, does not furnish a sufficient depth of anesthesia. Increasing the percentage, and therefore the amount, of nitrous oxid inhaled of course deepens the anesthesia, and this is often a great desideratum; but the increase in the depth of anesthesia thus gained simultaneously decreases the oxygenation, and herein lurks the danger. Most patients can tolerate a decreased oxygenation for a short time, and when one has had experience with this class of patients, the anesthetist thereby becomes emboldened to minimize the danger arising from subnormal oxygenation. Sooner or later, a patient who cannot tolerate even temporarily a decreased oxygenation reaches the service of such an anesthetist, and serious results sometimes
RAYMOND C. COBURN. NOTES ON NITROUS OXID ADMINISTRATION. JAMA. 1916;LXVI(11):799–800. doi:10.1001/jama.1916.02580370019007