Anyone using Nitronox in OB?

BabyRN2Be · Oct 5, 2004

I've never heard of this before, is this something similiar to Nitrous Oxide? If yes, how is it different. Tess, I assume you are in the States. What part of the country (West Coast, East Coast, Midwest, etc)?

If anyone has used this, I'd like to hear more as well. I'd like to know if it has any effect on breastfeeding.

shay · Oct 5, 2004

Wow, I thought that stuff went out of vogue in the '80's! I have only heard the "legend" of nitronox, never actually used it. From what other nurses have told me, they liked the fact that it was pt. controlled, and it worked well because it basically knocked the pt. out. But it did cause pretty depressed neonates, which is, from what I understand, one of the reasons lots of people didn't like it.

On an aside, some older nurses have also told me tales of other nurses taking a "whiff" of nitronox while on duty. Yikes.

SmilingBluEyes · Oct 5, 2004

If this is nitrous oxide, I have to ask:

why?

Seems to be a potentially dangerous and NON-effective way to deal with labor pain to me. I have used nitrous myself, in dental procedures like root canal, and found it to be more of a headache, not to mention, it does NOT block pain at all. I dont' get why we would want to use noxious gases in PREGNANT women at all. Any studies on effects on the fetus? How much does it take to really be effective? I had to have quite a bit to feel effects in the dentist's chair. I am concerned about long-term effects here.

Seems to me it is more of a liability than an asset in OB use.

SmilingBluEyes · Oct 5, 2004

Nitrous is very addictive from what I understand.........and abuse in the dental industry is known. I would not want it around an L and D floor. How do you co-sign "waste" of nitrous, rofl?????

Noahm · Oct 5, 2004

Nitrous is very addictive from what I understand.........and abuse in the dental industry is known. I would not want it around an L and D floor. How do you co-sign "waste" of nitrous, rofl?????

I delivered both my kids in England in 2000 and 2002 and used gas and air the whole way through my labours and was encouraged to do so. It didnt help take the pain away, but it did help the way I responded to the pain (weird I know). Both kids were alert and absolutely fine when born and they were both long labours. It also gave me a good way to focus my breathing. With my daughter I was on it for hours and hours and hours and she was awake and happy when born. I for one thought it really helped.

fergus51 · Oct 5, 2004

I used nitrous oxide with patients in Canada. It is great because it is patient controlled and excreted almost immediately, so we never had depressed newborns. They had a mask they could put up to their face and suck in the NO2. It wasn't flowing at a set rate or anything so they couldn't get too much. Some patients found it very helpful, others didn't. I know Americans don't seem to use it and seem very nervous about it, but it really wasn't a big deal.

jwk · Oct 5, 2004

I used nitrous oxide with patients in Canada. It is great because it is patient controlled and excreted almost immediately, so we never had depressed newborns. They had a mask they could put up to their face and suck in the NO2. It wasn't flowing at a set rate or anything so they couldn't get too much. Some patients found it very helpful, others didn't. I know Americans don't seem to use it and seem very nervous about it, but it really wasn't a big deal.

And how do you scavenge the waste anesthetic gas?

fergus51 · Oct 5, 2004

We actually used Entonox (oxygen/no2 mixed 1:1). I really don't know why it isn't used in the US.

Some links:

http://www.aafp.org/afp/20030915/1115.html

Nitrous Oxide

Nitrous oxide is widely used for obstetric analgesia in most developed countries, with the exception of the United States. More than 60 percent of women in Finland and the United Kingdom use nitrous oxide for pain relief during labor.24 The most commonly used mixture, a 50-50 blend of nitrous oxide and oxygen called Entonox, can be used in any stage of labor. The full analgesic effect usually is felt 50 seconds after inhalation. Entonox generally is self-administered as needed, but it can be administered continuously with medical supervision.

A systematic review of 11 RCTs comparing Entonox with placebo or other inhaled agents showed that Entonox provided a consistent but moderate analgesic effect.25 [Evidence level B, systematic review of lower quality studies] Approximately one half of study participants said Entonox provided significant pain relief. Adverse effects included nausea, vomiting, and poor recall of labor.

studies have shown it is safe for pregnant women, health care workers and newborns

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12011877&dopt=Abstract

In a recent study of methods of pain control used during labor in the U.K., the authors found that administration of nitrous oxide mixed with oxygen and administered by face mask is the most popular method (formerly popular in the U.S., this method is now virtually unavailable); http://www.midwifeinfo.com/topic-painrelief.php

fergus51 · Oct 5, 2004

And how do you scavenge the waste anesthetic gas?

I don't understand the question? The gas is only released to the pregnant woman when she sucks in from the mask, so it isn't floating around in the air making us all high. There is no waste.

fergus51 · Oct 6, 2004

http://www.babycentre.co.uk/refcap/542569.html

Entonox (gas and air)

• What is it?

• When should I use it?

• What are the advantages of Entonox?

• What are its disadvantages?

• Any useful tips?

• Related Topics

--------------------------------------------------------------------------------

What is it?

Entonox is a gas, made up of 50 per cent oxygen and 50 per cent nitrous oxide. The vast majority of maternity hospitals pump gas and air to all of their delivery rooms from a central supply, so it's always available when you want it. The gas is colourless and odourless, and the hospital's "scavenger system" will ensure that any gas that escapes into the delivery room is removed from the atmosphere.

When should I use it?

You can have gas and air whenever you want in labour. Simply put the mouthpiece between your lips or teeth and breathe deeply and evenly. This will operate a two-way valve that releases the Entonox for you to breathe in and takes away the carbon dioxide you breathe out. Continue to breathe deeply until you start to feel a little light-headed. Your hand will then drop away from your face and you will stop breathing in the Entonox. Within a few seconds, you will feel perfectly normal again.

What are the advantages of Entonox?

• Easy to use

• Under your control

• Doesn't stay in your system

• Takes the edge off contractions

• Contains oxygen that is good for your baby

• Can be used for a home birth

What are its disadvantages?

• Only a mild pain-killer

• May make you feel sick

• Dries your mouth out

Any useful tips?

• Start breathing the Entonox the very second you feel a contraction starting. It takes about 20 seconds for the gas to build up in your blood stream to a sufficient level to give you some pain relief. If you wait until the contraction really hurts, and then start the Entonox, it will be taking effect in between contractions!

• If you're offered gas and air through a rubber facemask, and the rubber makes you feel queasy, ask for a mouthpiece. It's easy to swap the mask for a mouthpiece.

• Have lots of sips of water in between contractions to keep your mouth moist.

• When you're pushing your baby out in the second stage of labour, have a little gas and air at the beginning of each contraction, but then put the mouthpiece to one side, and PUSH!

• Don't feel bad if gas and air isn't enough to help you cope with contractions. Try something else.

Jolie, BSN · Oct 6, 2004

With both of my girls, I labored comfortably for hours seemingly making little progress, then all of a sudden my water broke and I was complete. No indication for an epidural prior to that, and no time for one after that, despite excrutiating contractions. It sounds like this might have been a worthwhile option for me, but was not, to my knowledge, available. Too bad.

My guess is that it lack of use in the US has more to do with potential liability than anything else.