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Paediatric anaesthesia · Feb 2024
It's time to stop using nitrous oxide for pediatric mask induction.
- Diane W Gordon, Debnath Chatterjee, and Forbes McGain.
- University of Colorado School of Medicine, Aurora, Colorado, USA.
- Paediatr Anaesth. 2024 Feb 1; 34 (2): 104107104-107.
BackgroundMask induction of anesthesia for pediatric patients has included the use of nitrous oxide since the inception of pediatric anesthesia. However, the use of nitrous oxide precludes adequate preoxygenation. Additionally, pediatric physiology (less Functional Residual Capacity, higher oxygen consumption), increased risk of laryngospasm and lack of intravenous access increase the risk of a severe airway complication in the event of airway occlusion. Nitrous oxide does not facilitate tranquil mask placement on an unwilling child and does not meaningfully speed mask induction. Exposure to nitrous oxide has potential occupational health concerns and nitrous oxide has significant environmental detriment.ConclusionUtilizing other, evidence-based, techniques to facilitate tranquil mask placement will assure that patients have a pleasant induction experience and avoiding nitrous oxide will reduce the environmental impact, as well as improve the safety of, pediatric mask induction.© 2023 The Authors. Pediatric Anesthesia published by John Wiley & Sons Ltd.
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