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SHOULD WE JUST ACCEPT
SOMETHING BASED ON THE FACT THAT IT HAS BEEN AROUND FOR A LONG TIME?
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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.
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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.
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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.
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NB COULD SAY SOMETHING
ABOUT FACT THAT NITROUS IS CHEAP – i.e. 3rd world use.
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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.
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