Index of drugs

Treatment of short-term pain with mild to moderate intensity when a rapid onset and resolution of analgesia is desired.

Each cylinder contains compressed medical gas: nitrous oxide 50% v / v and oxygen 50% v / v at 170 bar (15 ° C).

Nitrous oxide at 50% has an analgesic effect, raises the pain threshold caused by various stimuli. The intensity of the analgesic effect depends mainly on the patient's mental state. At a concentration of 50%, nitrous oxide has a limited anesthetic effect, while it provides a sedative and sedative effect. The patient remains awake and easy to wake up, but to some extent loses contact with the environment. 50% oxygen concentration ensures good oxygenation and optimal oxygen saturation of hemoglobin. Both uptake and elimination of nitrous oxide occurs only in the lungs. Due to low solubility in blood and other tissues, saturation of both blood and target organs (o.u.n) is achieved quickly. Therefore, nitrous oxide has a rapid onset of analgesia, and after cessation of administration analgesia subsides quickly. Nitrous oxide is not metabolized in the human body.

The drug is contraindicated: in patients with signs or symptoms of pneumothorax, pericardema, severe emphysema, gas embolism or head trauma; after a deep dive with the risk of decompression sickness; after pulmonary vascular remodeling with extracorporeal circulation or aorto-coronary bypass without using extracorporeal circulation; in patients who have recently undergone adventitious injections of gas (e.g., SF₆, C₃F₈) until the gas is fully absorbed, because the volume of gas can cause pressure or volume to rise and result in loss of sight; in patients with a significant widening of the gastrointestinal tract. The drug is also contraindicated in patients with heart failure or cardiac dysfunction (eg after cardiac surgery) in order to avoid the risk of further worsening of cardiac function; in patients with persistent confusional symptoms, changes in cognitive function or showing any other symptoms of increased intracranial pressure; in patients with limited or reduced ability to cooperate and follow instructions, due to the risk that additional sedation due to nitrous oxide may affect natural defensive reflexes; in patients who have a deficiency of vitamin B₁₂ or folic acid and the genetic disorders of this system; in patients with facial injuries, if the use of a face mask may pose difficulties or danger.

Nitrous oxide affects the metabolism of vitamin B₁₂ and folic acid. The drug should be used with caution in patients at risk of vitamin B deficiency₁₂ and / or folic acid, e.g. with reduced supply or absorption of these Vitamins or a genetic disorder of the enzyme system involved in the metabolism of these Vitamins, as well as in immunocompromised patients. If necessary, substitution treatment with vitamin B should be considered₁₂ and (or) folic acid. Nitrous oxide inhibits methionine synthetase, reducing the formation of thymidine, which plays an important role in DNA formation, impairing DNA synthesis. This can lead to abnormalities and a decrease in myelin production and thus damage to the spinal cord. Effect on DNA synthesis is one of the likely reasons for the effects of nitrous oxide on hemopoiesis and fetal defects. During continuous administration (for more than 6 h), caution and monitoring of haematological parameters should be observed. A reduction in fertility has been reported in medical and paramedical personnel after repeated exposure to nitrous oxide in improperly ventilated rooms. Due to the content of nitrous oxide, the drug increases the pressure in the middle ear and other cavities filled with gas. Nitrous oxide can be used in children who are able to carry out instructions regarding the use of the device.

Avoid use in the first and second trimester of pregnancy, because the inhibition of methionine synthetase by nitrous oxide can cause side effects in early pregnancy. The drug can be used in the third trimester and during delivery (if used in the perinatal period, newborns should be observed for any adverse reactions). The drug can be used during breastfeeding, but not at the time of feeding.

Common: dizziness, feeling of reduced contact with the environment, euphoria, nausea, vomiting. Uncommon: severe tiredness, pressure in the middle ear, flatulence, increased intestinal gas volume. Very rare: polyneuropathy, paresis of the lower limbs, myelopathy. Frequency unknown: megaloblastic anemia, leukopenia, psychosis, confusion, anxiety, respiratory depression, headache.

The drug should be administered by qualified personnel with access to an appropriate resuscitation apparatus. The drug is administered by inhalation through a face mask in self-breathing patients, able to understand and follow instructions on how to use the device and the mask. Gas delivery is regulated by the patient's breath. In children or other patients who are unable to understand and follow the instructions, the medicine is administered by a competent medical professional who keeps the mask in place and actively controls the administration. In such cases, it can be fed at a constant gas flow. Due to the increased risk of significant sedation and loss of consciousness, this form of administration should only take place under controlled conditions. Administration of the drug should be started shortly before the desired analgesia. The analgesic effect appears after 4-5 inhalations and reaches its maximum in 2-3 minutes. Administration should be continued throughout the painful procedure or as long as analgesia is required. After discontinuation of administration / inhalation, the effect will disappear quickly within a few minutes. After administration, allow the patient to wake up in a calm and controlled environment for about 5 minutes or until the patient's level of orientation and awareness is satisfactory. In patients without risk factors, the drug can be administered for up to 6 hours without monitoring blood counts. Depending on the patient's individual response to analgesia, additional analgesics may be necessary. In dentistry, it is recommended to use a double mask; alternatively, a nasal or nasal-buccal mask with adequate ventilation is used. It is not recommended to be administered through the endotracheal tube. If the drug is to be used in patients who breathe through the endotracheal tube, it should only be administered by medical personnel trained in the use of anesthesia.