• C Lévêque, Y Mikaeloff, J Hamza, and G Ponsot.
• Département d'anesthésie-réanimation, hôpital Saint-Vincent-de-Paul, 82, avenue Denfert-Rochereau, 75014 Paris, France. doclevq@yahoo.com
• Arch Pediatr. 2002 Sep 1;9(9):907-12.

AimWe studied the use of premixed nitrous oxide and oxygen in 80 patients with neurologic diseases.Patients And MethodsMean ages ranged 10 +/- 5 yrs. Twenty-three patients (29%) were mentally retardated among which 17 of them presented with severe epilepsy. Painful procedures consisted of: lumbar punctures (80%), intravenous access (7), gastric endoscopy (6), skin biopsy (4), gastrostomy tube management (3). High-risk children were continuously monitored using ECG, non invasive blood pressure and transcutaneous oxygen saturation. We studied acceptation of the inhalation, vital signs, satisfaction of children, parents, medical and nursing staffs; side effects were compared with a group of healthy children undergoing venous access before induction of anesthesia.Results And DiscussionAcceptation increased with age. No significant changes in vital signs variables were observed. Satisfaction rate regarding the method was 88% for all children, parents, physicians and nurses. No serious undesirable event (as respiratory depression, seizure, inhalation of gastric content) occurred in these patients. The more frequent side-effects were: drowsiness during and after inhalation (35 and 9% respectively in the handicapped patients); nausea and vomiting (8%), headaches (3%), were more frequent than reported in literature but there were 25% of meningitis among our patients.ConclusionPremixed nitrous oxide and oxygen was effective for reducing procedural pain and anxiety in children with neurological disorders, even in severely handicapped patients, with minor side-effects.

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