Opinion Review
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Mar 9, 2022; 11(2): 93-104
Published online Mar 9, 2022. doi: 10.5409/wjcp.v11.i2.93
Current status of nitrous oxide use in pediatric patients
Nishkarsh Gupta, Anju Gupta, Vishnu Narayanan M R
Nishkarsh Gupta, Department of Onco-Anesthesiology and Palliative Medicine, AIIMS, New Delhi 110029, Delhi, India
Anju Gupta, Vishnu Narayanan M R, Department of Anesthesiology, Pain Medicine and Critical Care, AIIMS, New Delhi 110029, Delhi, India
Author contributions: Gupta N and Gupta A contributed equally to this work; Gupta N contributed to the concept and data retrieval; Gupta N and Gupta A designed the narrative review, analyzed the data and wrote the manuscript; Gupta A and Narayanan M R V retrieved the data and performed the data analysis and research; all authors have read and approved the final manuscript.
Conflict-of-interest statement: There are no conflicts of interest for any of the authors. None of the authors has received any fees for serving as a speaker, a position, such as consultant and/or an advisory board member or research funding from any organization. Also, the authors do not hold stocks and/or shares in any such firm and do not have a patent.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Anju Gupta, MD, Assistant Professor, Department of Anesthesiology, Pain Medicine and Critical Care, AIIMS, Room No. 6, Porta Cabin, Fourth floor teaching block, New Delhi 110029, Delhi, India. dranjugupta2009@rediffmail.com
Received: April 25, 2021
Peer-review started: April 25, 2021
First decision: June 17, 2021
Revised: July 4, 2021
Accepted: February 25, 2022
Article in press: February 25, 2022
Published online: March 9, 2022
Abstract

Nitrous oxide is one of the most commonly used inhalational anesthetic agents used in practice. It is a cost-effective, pleasant, safe, and versatile anesthetic agent with many desirable properties like good quality analgesia, decreased awareness, accelerated induction and recovery from anesthesia, and reduced utilization of other expensive inhalational agents with potential cost savings. The use of nitrous oxide has been questioned by a lot of studies and case reports perceiving its adverse systemic, hematological, immune, and neurologic adverse effects. However, the literature in the recent past has tried to resolve the controversies related to its use. The concerns over an increase in cardiovascular complications and mortality following nitrous oxide use have been negated by recent data. However, its use in certain vulnerable populations like children with cobalamin and folate deficiency or defects in their metabolic pathways remains a cause of concern for its toxic effects. In this narrative review, we aim to discuss the pharmacological properties of nitrous oxide, the potential advantages and drawbacks of the use of nitrous oxide in children, address the neurodevelopmental and other systemic effects, and throw light on the evidence regarding the safety of nitrous oxide use and its current role in pediatric procedural sedation and anesthesia practice. The literature related to its use in the pediatric population for painful procedures and surgeries has been summarized.

Keywords: Child, Nitrous oxide, Vitamin B12, Vulnerable populations, Anesthesiology, Anesthetics, Folic acid, Metabolic networks and pathways

Core Tip: The literature is insufficient presently to advise either the routine use or complete elimination of nitrous oxide, and further research is needed to fully establish its role in pediatric anesthesia practice. No major adverse effects have been reported in large trials on the use of nitrous oxide in children despite the prevailing concerns over its safety in this population. A reasonable and balanced approach should be adopted to individualize its use considering its risks and benefits as related to a particular case.