Inhaled Nitrous for laboring patients

[narcusprince]

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At my current hospital they use inhaled nitrous for laboring moms. I am not a fan as the patients progress however when they request an epidural most of them are 10cm and ready to push. I am also concerned abouf the risk of aspiration too. I am not a fan.

 

[urge]

Popular in England. Seems to be ok.

 

[norwood]

Popular in England. Seems to be ok.

England uses Entonox, which is a basically a 50:50 o2/n2o mix administered to oneself by a mask that only releases the stuff while the pt is holding down a little button. It's like a nitrous PCA. Same idea as an IV PCA: if you get too much, you fall asleep and won't hit the button anymore. I would give family members the same speech about how only the pt can hit the button.

Edited to fix the brand name. Sorry, haven't been to England in awhile!

 

[deleted59964]

we do the same -- but no button, triggered by inspiratory effort
for what it's worth, about 70% of women are sucking on entonox when I turn up to do an epidural -- haven't seen a single problem from it.

 

[risnwb]

We see them using it pretty regularly. I'm all for it because they get plenty of women through labor without an epidural and I'm employed by hospital so have no incentive to sit in hospital and babysit an epidural.

 

[Consigliere]

We use it where I'm at; popular with the touchy queery crowd.

 

[Twiggidy]

If you guys want to come sell my hospital on this, I'll be a happy man (and I'm sure wifey would be happy to see me at home more).

 

[jwk]

Aren't there scavenging requirements when N2O is used?

 

[Planktonmd]

I didn't realize there are so many places in the U.S. where nitrous is used for labor!
Is this a new practice?

 

[Urzuz]

Aren't there scavenging requirements when N2O is used?

Where I trained, the nitrous was only delivered when the woman engaged the mask and inspired (though I can't remember the concentration...maybe 50%?). There was not a formal scavenging system, but I imagine the amount that escaped was negligible by clinical standards. I'm sure they must have tested the ppm in the room or approximated it before they instituted this practice.

In my experience, I would say a solid 80-90% of the patients who used nitrous eventually ended up getting an epidural. Motivated patients who were deathly afraid of needles were able to get by with it plus some fentanyl though.