Nitrogen oxide

Nitrous oxide has a narcotic analgesic effect.

[1], [2], [3], [4], [5]

Indications Nitrogen oxide

It is used in the procedures of complex anesthesia through inhalation (a special apparatus is used) - together with other analgesic drugs, and in addition opiates and muscle relaxants.

Used for systemic anesthesia, which does not require deep anesthesia and muscle relaxation (for example, general surgical procedures, gynecological or dental operations, and analgesia during the delivery procedure).

Assign to potentiate the anesthetic analgesic effect of other anesthetics (for example, therapeutic analgesic anesthesia after the end of the operation), and in addition to shock states of traumatic origin (for the purpose of prevention).

Also, the medication is used for a variety of pains, including acute coronary insufficiency, acute pancreatitis, or  myocardial infarction.

It can be prescribed for analgesia when performing a variety of medical procedures or when there is a need to switch off consciousness.

[6], [7], [8], [9], [10]

Release form

The release of medicinal substance is realized in cylinders with a capacity of 10 liters.

[11]

Pharmacodynamics

The medication is used when performing inhalations in order to introduce the patient into anesthesia. Nonspecific way, it affects the activity of neuronal membranes and suppresses the transfer of impulses from them to the central nervous system, while also altering the cortical-subcortical connections.

Nitrous oxide has a powerful analgesic effect. In small portions, the drug can lead to the development of mild drowsiness and a feeling of intoxication.

After inhalation, the analgesic phase develops after a few minutes (if at the same time a minimum of 80% of nitrous oxide is contained inside the gas mixture, and oxygen is another 20%). First, a short (about 6-8 minutes) is observed, but a rather noticeable phase of excitation, and then the first stage of entry into surgical anesthesia develops.

General anesthesia is maintained with nitrous oxide values of 40-50%, and also according to this increased proportion of oxygen. It should be taken into account that, at the same time, there is no sufficient relaxation of the muscles of the skeleton, so that in order to obtain the necessary therapeutic effect, nitrous oxide must be combined with the rest of the muscle relaxants, and also with inhalants.

Awakening occurs after 3-5 minutes after stopping the gas supply. There is an increase in the level of heart rate and narrowing of peripheral vessels. There may also be an increase in ICP values and suppression of respiratory activity.

[12], [13], [14],

Pharmacokinetics

The medication penetrates into the lungs, and then moves to the circulatory system. The substance resides inside the plasma in a dissolved form, without undergoing metabolic processes.

Complete excretion of the unmodified element is carried out through the lungs after 10-15 minutes. A small part of the substance is also excreted through the epidermis. The half-life is about 5-6 minutes.

The medication passes well through the BBB, and in addition, through the placenta.

[15], [16], [17], [18], [19], [20], [21], [22], [23]

Dosing and administration

The medication is prescribed in the form of inhalations: simultaneously with oxygen, as well as other substances for injection into the anesthesia through inhalation. Introduced through special apparatus for gas anesthesia. First, the mixture should include 70-80% nitrous oxide and 20-30% oxygen.

To eliminate pain or as a preventive agent, a medical anesthetic is performed, which contains dinitrogen oxide (part is about 40-75%).

To quickly obtain the required depth of systemic anesthesia (introductory), dinitrogen oxide is used in a proportion of 70-75%, and 40-50% is required to maintain this state. If necessary, the mixture can include components such as ether, barbiturates or fluorotane. To avoid the appearance of hypoxia of a diffuse character after stopping the supply of nitrous oxide, it is required to continue feeding oxygen for a further 4-5 minutes.

To eliminate pain during labor, a method of autoanalgesia of discontinuous type is used, when nitrous oxide is introduced in the amount of 40-75%, and also oxygen. The parturient should inhale this substance at the moment when the contractions begin, and exhale at their peak or after their termination.

If there is a need to switch off consciousness during the time of medical manipulations, inhalations containing 25-50% of oxygen are performed.

For children, portions are selected individually. Inhalations are allowed in which at least 30% of oxygen is contained, and at the end they need to supply oxygen during another 5 minutes to prevent the development of hypoxia.

To reduce the increased emotional excitement, and in addition to vomiting with nausea and to increase the drug effect, it is necessary to perform premedication in the form of intramuscular injections of a 0.5% solution of diazepam (1-2 ml or 5-10 mg) or 0.25% solution of drug droperidol (2-3 ml or 5-7.5 mg).

[26], [27], [28], [29], [30]

Use Nitrogen oxide during pregnancy

Nitrous oxide in inhalations is allowed to be used for analgesia in childbirth, but its continued use can lead to miscarriage or adversely affect the subsequent development of the child. If there is a need, the medicine is allowed to be used in small concentrations, at which the proportions to oxygen are 1k1. Use should be short-term - maximum 2-3 breaths of substance.

It is completely forbidden to use medicament when lactating. If such inhalation is required, at this time it is necessary to refuse breastfeeding.

Contraindications

The main contraindications:

• presence of hypersensitivity to nitrogen oxides;
• hypoxia;
• various pathologies in the field of NA;
• alcohol intoxication or alcoholism in a chronic stage, because the use of drugs can lead to the appearance of hallucinations or feelings of excitement.

Caution in the use of the drug is required for TBI, increased ICP rates (also if they are available in history), or with tumors detected inside the skull during the diagnosis.

Side effects Nitrogen oxide

Taking into account the phase of anesthesia, various negative manifestations can develop:

• at the stage of introduction into anesthesia: bradycardia, an arrhythmia of the supraventricular character, or inadequacy of the circulatory processes may develop;
• at the exit stage: the development of hypoxia of a diffuse nature, and besides this postnarcotic delirium, against which hallucinations appear and a feeling of confusion of consciousness, anxiety, nervousness and excitement (including prolonged) is noted;
• long-term use: the occurrence of vomiting or nausea and drowsiness, (more than 2 days), and in addition anemia develops, respiratory function suppression, bone marrow disorder (pancito- or leukopenia), and polyneuropathy. It is also possible the emergence of chills postoperative character and hyperthermic crisis.

[24], [25]

Overdose

Among the signs of poisoning, such expressed disorders of the function of SSS: having a different nature of arrhythmia, suppression of respiratory activity, bradycardia, lowering blood pressure and the appearance of delirium and acute form of hypoxia.

To eliminate these violations, such procedures should be carried out (taking into account the condition of the victim):

• for the treatment of bradycardia, the administration of atropine in a dose of 0.3-0.6 mg is required;
• at an arrhythmia it is necessary to correct parameters of gases inside of a blood;
• with a decrease in the level of blood pressure or circulatory failure, the patient should be administered plasma or plasma substitutes, and in addition to reducing the depth or stopping general anesthesia;
• with a crisis of hyperthermic nature, it is necessary to stop inhalation, to increase the supply of oxygen, and in addition to administer the antipyretic to the patient and to eliminate the water-electrolyte balance disorders along with metabolic acidosis. Also, if necessary, dantrolene is used (intravenously via a dropper, in a dose of 1 mg / kg, the total maximum allowable dosage is 10 mg / kg);
• to prevent recurrence of the crisis for 1-3 days after the surgical procedure, it is required to administer dantrolene intravenously or to take it orally (it is recommended to take a dosage of 4-8 mg / kg / day, divided into 4 divided doses). When suppressing respiratory activity or inadequate pulmonary ventilation after the end of the operation, a reduction in the amount of anesthetic (if it continues to be used) and ensuring air pass through the respiratory ducts (or patient connection to the ventilator) is required;
• In case of delirium, a small portion of the opiate should be administered to the patient after it is removed from the general anesthesia.

[31], [32], [33], [34]

Interactions with other drugs

There is an increase in the effect of drugs when it is combined with opiates, neuroleptics, substances for inhalation anesthesia, tranquilizers and antihistamine medicines.

Combination with atropine leads to an increased likelihood of bradycardia, which can not be stopped; combination with amiodarone increases the risk of lowering blood pressure; Combination with xanthines increases the likelihood of arrhythmia.

Potentiation of the effect on CAS (decrease in heart rate, as well as minute heart volume) occurs with simultaneous administration with fentanyl and its derivatives.

When combined with nitrous oxide, potentiation of the effect of such antihypertensive agents as ganglion blockers with diazoxide, diuretics and anticoagulants (including derivatives of indandion and coumarin), and in addition to these drugs that can suppress the function of the central nervous system and the activity of respiratory centers.

[35], [36], [37]

Storage conditions

It is recommended to keep nitrous oxide in a place closed from the penetration of small children. The temperature is not above 25 ° C.

[38], [39], [40], [41], [42]

Shelf life

Nitrous oxide can be used within 5 years from the date of manufacture of the drug.

[43], [44], [45], [46], [47], [48],

Analogues

Analogues of the substance are preparations Ctikoksidal, as well as Dinitrogen Oxide.

[49], [50], [51], [52], [53], [54], [55], [56]