SHOULD WE JUST ACCEPT SOMETHING BASED ON THE FACT THAT IT
HAS BEEN AROUND FOR A LONG TIME?
Millions of patients treated safely over the years. Reason the agent has remained for so long is because it is useful and relatively safe. There are contraindications, but this is true of any drug, and nitrous oxide is certainly a less potent
agent than many modern agents.
Conversely, historical success should not alone justify
the use of nitrous oxide, and it is right that we test
using the current evidence base. There
is a strong correlation between post operative
vomiting and nitrous oxide, and its effect on immunological, haematological etc… systems is gradually coming to light. Initial use was demonstrated
by an entertainer, not a doctor.
HINDSIGHT: we assume that something is safe and
then years after its discovery begin to investigate its effects.
I would conclude that like a fine wine, nitrous oxide has
aged well. Yet its status should not just be accepted because of its age; it should be judged
against the most modern vintages of anaesthetics and
used accordingly and in line with current evidence. By
setting nitrous oxide in its historical context, I hope to have demonstrated both sides of the argument. There are specific situations where the agent should not be used, or be used with caution, but this is the
same for any drug.
NB COULD SAY SOMETHING ABOUT FACT THAT NITROUS IS CHEAP –
i.e. 3rd world use.
Sicker patients these days – perhaps as we treat and save
sicker and sicker people, the effects of once
innocuous drugs become apparent.
Nitrous not realised as being toxic in the past
as these sort of patients were not understood, or at least not treated effectively.