Anyone using Nitronox in OB?

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Is anyone using Nitronox for labor pain relief? If so, please share the advantages and disadvantages. What are the nursing implications? What effect does it have on the newborn?

If anyone is willing to share a protocol that would be wonderful.

Thanks!

Never heard of this either, but I am not sure I like the sound of it. Who wants a mom knocked out? That does not sound like a great experience to me. Patient controlled epidural is the best thing I have used.

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Never heard of this either, but I am not sure I like the sound of it. Who wants a mom knocked out? That does not sound like a great experience to me. Patient controlled epidural is the best thing I have used.

I used gas throught both my labours and was not at all knocked out. I felt a bit kooky though. :chuckle But I was still totally with it and aware.

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Never heard of this either, but I am not sure I like the sound of it. Who wants a mom knocked out? That does not sound like a great experience to me. Patient controlled epidural is the best thing I have used.

Moms aren't knocked out. This isn't like twighlight sleep. They are completely conscious and control how much gas they take in.

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Specializes in Obstetrics, Management, Informatics.

Thanks for the information fergus51 and others. The reason I asked about Nitronox is because I work in a rural hospital that does 50-60 deliveries a month. Our anesthesiologists are really good about placing epidurals for us during the day, but at night it is a different story (they don't want to come in...long story). So we are looking at other options and I heard about Nitronox from a nurse that comes from Canada. It is her opinion that Nitronox is wonderful for laboring women and I wanted to know if anyone in the US uses it, and if not, why not.

Thanks!

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Myles textbook for midwives had a good section on use for labor... might be worth a read if your facility is considering this.

Jeremy

Thanks for the information fergus51 and others. The reason I asked about Nitronox is because I work in a rural hospital that does 50-60 deliveries a month. Our anesthesiologists are really good about placing epidurals for us during the day, but at night it is a different story (they don't want to come in...long story). So we are looking at other options and I heard about Nitronox from a nurse that comes from Canada. It is her opinion that Nitronox is wonderful for laboring women and I wanted to know if anyone in the US uses it, and if not, why not.

Thanks!

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Specializes in Home Health Case Mgr.

Nitrous is used a lot in EMS services in the UK and Australia..It is quick, wears off very quickly, rarely is condraindicated with other meds......BUT because the medical establishment in the US can be bullheaded sometimes and if it isn't their idea, forget it.........our loss. I have read articles in EMS journals about it's effectiveness in the EMS setting...probably could work well in any pain setting.

Sometimes we in the US are ahead of the game and sometimes we are behind.

Peace

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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.

Unless it's a closed system (which it isn't) N20 is released into the room either from the mask itself or when the patient exhales. It may not make you "high", but that's not the point. It's the chronic exposure that is problematic.

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Moms aren't knocked out. This isn't like twighlight sleep. They are completely conscious and control how much gas they take in.

50%N20/O2 does not equal "completely conscious". I've had this same combination for dental work - it definitely takes the edge off, and I wasn't unconscious, but I sure wasn't fully alert either. I certainly was not "completely conscious".

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jwk, the system they have just delivers the gas to the mom when she sucks in. She has to actively try to get it out. It isn't just flowing freely. The link I posted on page 1 adressed healthcare workers' safety. It has been proven to be safe for those in the room (that's why they are allowed to use it in dental offices as well). I'll try to post it on here.

I would wonder how you were using it in the dental office if you felt a little loopy. I am assuming you kept the mask on and were constantly receiving it, which would account for you feeling not quite with it. That isn't the case in labor. Generally, the woman will feel a contraction coming on, put the mask to her face and take a few deep breaths, then stop when it's done and put the mask back down. So, the woman may breathe it for 90 seconds at a time tops. I have never had a patient say they felt unaware or less than conscious. If they do feel wierd or don't like it, they just don't use it anymore. Since it is excreted pretty much immediately they don't have to worry about it for more than a minute or two after stopping. That's what I really liked about it. It is so short acting that you don't get the kind of problems you do with narcotics and it can be used right to the end of labor without affecting the baby.

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This article looked at occupational exposure. Since the rooms are well ventillated and it isn't used in a continuous way and it is only 50% nitrous oxide, workers are not exposed to nearly enough gas in L&D to cause problems. The masks do have some sort of scavenger system, I'll try to find some info on it for you.

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

Nitrous oxide is not a potent labor analgesic, but it is safe for parturient women, their newborns, and health care workers in attendance during its administration. It appears to provide adequately effective analgesia for many women.

Another source:

The area should be well ventilated to prevent the accumulation of nitrous oxide. The occupational exposure standard (OES) for long term exposure is 100 parts per million (ppm)

Reynolds J, Parfitt K, Parsons A & Sweetman S, editors.

The Extra Pharmacopoea, 31st Edition.

England: Royal Pharmaceutical Society of Great Britain; 1996

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Here is a link with pictures of the actual mask and scavenging system one hospital uses in BC:

http://www.aihabc.org/presentations/2003sept/0903.pdf

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The only place that I've really seen it used in the US is San Francisco. I had seen it on "World Birth Day."

Side note: I REALLY hate those reality TV L&D programs, but this was pretty worthwhile. It had shown births from around the world and was VERY interesting.

I had seen that they used the nitrous in England, as some others had pointed out.

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