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NEWS: The Age 05 May 05: Patients wake in fright after anaesthetic gas

BigTrancer

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Patients wake in fright after anaesthetic gas
By Julie Robotham Medical Editor
May 5, 2005


The nitrous oxide gas used in most general anaesthetics is unsafe and should be discontinued, say Australian doctors who have found it doubles the rate of serious vomiting and pneumonia after surgery and raises the risk of wound infections.

Their study of 2050 patients also showed that those who had undergone surgery were slower to recover and likely to stay in hospital longer if gases used to keep them unconscious included nitrous oxide as a base, rather than oxygen alone or oxygen and air.

Paul Myles, director of anaesthesia at The Alfred Hospital in Melbourne, said: "This is going to really surprise people ... nitrous oxide is used in 80 per cent of anaesthetics. It's the stock in the stew. It's the foundation of anaesthesia and has been that way for 160 years."

Professor Myles, who led the 20-hospital international study, said he had already stopped using nitrous oxide in his own practice, though "it possibly has a role in simple surgery for young, healthy patients".

Because it changed the way the body metabolised vitamin B12 and folate, it was also possible nitrous oxide could cause immune system and heart problems, nerve damage, cancer and birth defects, Professor Myles said. Those potential effects, combined with those demonstrated by the new study, spelled "the end of nitrous oxide" in general anaesthesia, he said.

But it would still have a role in securing fast pain relief, such as after injury or while giving birth.

The preliminary results will be presented in Auckland on Saturday to the Annual Scientific Meeting of the Australian and New Zealand College of Anaesthetists.

Richard Halliwell, an anaesthetist at Westmead Hospital who recruited 68 patients for the trial, said the safety of nitrous oxide had never been fully evaluated before. "It came into practice before there was rigorous testing of safety or efficacy of drugs and completely escaped current testing standards," he said. "The results suggest people should strongly reconsider its routine use - particularly in longer procedures and sicker patients because they have less margin to cope with the adverse effects."

Michael Cousins, the College of Anaesthetists' president, said a phase-out of nitrous oxide would be good news for patients.

"If we eliminate nitrous oxide from the equation there will be a lot fewer people feeling very sick," he said. Anaesthesia had already become much safer and easy to tolerate, and the death rate attributed to it was now less than one in 100,000, said Professor Cousins, who is also head of anaesthesia and pain management at Royal North Shore Hospital.

From:http://www.smh.com.au/articles/2005/05/04/1115092568710.html
I'm surprised! This is a very interesting development.

BigTrancer :)
 
Beat me to it BT. was just going to post this myself....interesting news that's for sure....
 
Because it changed the way the body metabolised vitamin B12 and folate, it was also possible nitrous oxide could cause immune system and heart problems, nerve damage, cancer and birth defects, Professor Myles said. Those potential effects, combined with those demonstrated by the new study, spelled "the end of nitrous oxide" in general anaesthesia, he said.

In many ways, I don't find those claims all that surprising. I've always thought the B12 thing was a worry, and during my past lengthy binge with the "iron lung" I had several instances of nasty heart palpitations. Very scary thought to think there are concerns regarding cancer and birth defects..8(

I've known several women, who during childbirth found nitrous to be quite disturbing. I could see how it could be following use as a GA, particularly for those inexperienced with it.
 
"...said the safety of nitrous oxide had never been fully evaluated before"

What the hell ? They never, ever evaluated the use of Nitrous Oxide as an anaesthetic....extensively??

That is rather disturbing.
 
KostoN said:
"...said the safety of nitrous oxide had never been fully evaluated before"

What the hell ? They never, ever evaluated the use of Nitrous Oxide as an anaesthetic....extensively??

That is rather disturbing.

^^ hah yes, specially after using it for 160years!!!
 
This is pretty alarming considering how widespread the use of nitrous oxide is. On another note though, if the hospitals have any trouble getting ride of all their NOS i'll gladly come and dispose of it, free of charge ;)
 
Theoretical question for everyone: if nitrous oxide is proven to be harmful to your health, will you give up (or consider giving up) recreational use through whipped cream bulbs? How much will this news change your risk/benefit assessment (if at all)?
 
It depends on how harmful it really is. Most concerning to me is that it is a carcinogen, though in truth I dont think this will stop me having it occasionally (as in, <4 times in a year), as it just seems to go so well together with other substances.

Excluding possible damage from lack of oxygen, I imagine a 'balloon' or two wouldnt cause the same level of damage as inhaling nos for longer periods of time as one would do while under anaesthetic. Since I hardly use the stuff anyway, I dont think this new infomation will stop me from using it again.
 
^^^ mind you, when you're breathing N20 under anaesthetic it's mixed with oxygen - all properly regulated. IMO, not as dangerous (although it is for extended periods of time) as idiots hyperventilating into balloons for 30 seconds, bulbs every 5 minutes...

I too am surprised they've only become 'aware' of the health risks associated with nitrous now though...seems strange cos it's been around for so long.
 
I agree with you about the mixture of oxygen and nitrous oxide compared to just straight lungfulls of N20, thats why I said "excluding damage from lack of oxygen" ;)

Assuming one doesnt take "bong" style hits (as in, taking in as much as you can in one breath) of nitrious, and instead takes it in small short breaths, each followed by a breath of air, surely this would decrease the damage that would occur with just straight nitrous oxide. Thats how I usually consume N20, because I always considered it would be less harmful to do it in that manner. Someone please correct me on this if im wrong.

I too think its surprising that we've only just figured this out. If there really are so many dangerous side effects, I wonder why noone ever really picked up on them in the past hundred or so years.
 
so many things wrong in this thread.

the article is highly summarised. i'm awaiting the anaestheia conference presentation for a more detailed report.

none of the conclusions from the article is new to medicine. the study was designed to see if NO was of any benefit to anaesthesia not to study its pharmacology (which we already know heaps about).
 
its pharmacology (which we already know heaps about)
i beg to differ;
Im dead certain that i read, and recently, that we know pretty much nothing about the action of nitrous; how it actually causes dissociation/pain relief - just that it does.
I've searched but cant find that reference... i'd welcome proof that i'm wrong while i continue to search...

Theoretical question for everyone: if nitrous oxide is proven to be harmful to your health, will you give up (or consider giving up) recreational use through whipped cream bulbs? How much will this news change your risk/benefit assessment (if at all)?
Probably not. i assume when i take hits of nitrous, as with any drug, that there are risks. there is risk involved in everything, and unless something really, really damning came up, i'll continue my use... There are that many recorded uses of NOS through out history that any horrible health concerns (past what they already know) would have come to light after 160 years of use, i would say.
 
true we don't know alot about the pharmacodynamics of inhalational agents but have a read of an anaesthetic textbook and you'll see that none of the information is new
 
Yeah. i cant find that reference, so i should probably retract that statement... ^^

but anyway, im not too worried about the folate issue, but the B12 depletion sort of bothers me. would pre and/or post loading with a B supplement like Berocca be advisable? would it negate the effects?

cheers
 
Ritalin_boy said:
but anyway, im not too worried about the folate issue, but the B12 depletion sort of bothers me. would pre and/or post loading with a B supplement like Berocca be advisable? would it negate the effects?
Have a read through the nitrous FAQs etc, they recommend using a specific B12 supplement.
 
ABC Version

http://www.abc.net.au/news/health/sophie_scott/newsitems/s1360963.htm

Study finds nitrous oxide can have serious side-effects

Australian doctors may need to rethink which drugs they use in surgery.

A study has found one of the most commonly used anaesthetics can cause a range of potentially serious side-effects.

Nitrous oxide, or laughing gas, has been used as an anaesthetic for more than 150 years, but a new study raises concerns about its safety.

"This study was conducted in patients having surgery more than two hours and they were generally fairly unwell,” Associate Professor Kate Leslie, from the Australian and New Zealand College of Anaesthetists, said.

“This study provides evidence that we should not be using nitrous oxide in those patients."

The review of 2,050 patients in 20 hospitals around the world found those given the drug were more likely to suffer vomiting and pneumonia.

Patients were also slower to recover from surgery.

"There are other more serious side-effects, such as trouble with the heart, lungs and trouble with the immune system," Associate Professor Leslie said.

Associate Professor Leslie says these conditions occurred in a smaller number of patients.

Nitrous oxide impairs the immune system and also limits the amount of oxygen patients can be given, which helps prevent infection.

Anaesthetists believe these findings will make many doctors reconsider using the gas, particularly for operations lasting more than two hours.

But not all doctors agree, saying nitrous oxide has been used safely in more than two million operations in Australia each year.

"If it was the devil personified, that some people would proclaim, I think a few of us might have noticed," Associate Professor Greg Knoblanche, director of anaesthesia at Sydney’s Royal North Shore Hospital, said.

He believes all anaesthetics carry a level of risk and side-effects and it is a matter of weighing up the pros and cons of individual drugs.

More details from the study will be presented at the Australian and New Zealand College of Anaesthetists scientific meeting this weekend in New Zealand.
 
there's a bit of discussion in this thread, but what are thoughts on the relevance of this to recreational use? of course, one goes a lot longer without oxygen when hyperventilating into a balloon than when they're at the dentist, but is that likely to increase negative effects exponentially, or just mildly?

of course, i might be just asking unanswerable question, but perhaps some of the wiseheads around here might have a good idea (*stares at phase_dancer* ;)).
 
I can only guess that it would be more likely to exacerbate the effects, as oxygen deprivation is common with rec use of N2O. Just whether this is a little or a lot, I wouldn't know.
 
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