Nitrous in OB

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Maverikk

Maverikk

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never used it..looking for some help/advice and advantages/disadvantages..anyone use it outside the OR? I’ve seen how to do it with the end tidal co2 nasal cannula but that’s about it
 
I'd stick with epidurals for pain. If the patient refuses one the rest falls under the doulas turf
 
Nitrous is garbage. In my small n, pts could've either made it without nitrous or should've asked for an epidural in the first place.
 
Newtwo said:
Why?
Click to expand...
Tachyphlaxsis. As soon as it wears off its done pain goes from tolerable to 10/10. This puts me in the scenario of putting in a cle for someone at 8cm and moving around. Also you consent them for the epidural after they had nitrous running? Can mom consent if she is inhaling nitrous? Too many questions put in a CLE and be done.....
 
Agreed. Nitrous COULD be useful if a patient cannot receive an epidural, though the same can be said for Remi. But as a primary method of pain control, it's but even in the same stratosphere.
 
Can you consent a pregnant lady at 8cm anyway?

Left lateral epidurals and it doesn't matter how much she wants to move, she can't. And I'd imagine even fentanyl wearing off would have a similar effect

N2o has been given to billions of people and enigma 2 tells us it doesn't kill people anymore than any of the rest of them. Even it's ponv rates aren't bad if you give prophylaxis. I don't use it much but it's not an awful drug. It's a great drug.

When we all get xenon then yeah dump it but until then let's not rag on the drug for the wrong reasons
 
Newtwo said:
Can you consent a pregnant lady at 8cm anyway?

Left lateral epidurals and it doesn't matter how much she wants to move, she can't. And I'd imagine even fentanyl wearing off would have a similar effect

N2o has been given to billions of people and enigma 2 tells us it doesn't kill people anymore than any of the rest of them. Even it's ponv rates aren't bad if you give prophylaxis. I don't use it much but it's not an awful drug. It's a great drug.

When we all get xenon then yeah dump it but until then let's not rag on the drug for the wrong reasons
Click to expand...
Totally depends what you're using it for. Great in the OR but for pain control in the second stage of labor, it's simply not even close to being as effective as the gold standard.
 
Basically never cause I only know one other left lateralist out of maybe 400 staff/residents I've worked with.

It's a beautiful thing

Ok I do agree out on the labour ward n2o is pants. And considering it's just exhaled all over the room yeah it prob should be limited use...
If they don't call me about it I don't care really what the woman takes. If she wants tens and whale sounds so be it
 
Newtwo said:
Can you consent a pregnant lady at 8cm anyway?
Click to expand...

Of course you can.

You're not really suggesting that a person experiencing pain is incapable of providing consent, are you?
 
Newtwo said:
Can you consent a pregnant lady at 8cm anyway?
Click to expand...

The reality is that all labor patients should consent to anesthesia when arriving on L&D, although this is not done in practice. If the logic is that a patient receiving pain drugs is no longer able to give consent, well, then that's similar to all the ER cases that get drugged up before coming to the OR. Almost all of them are consented under the influence. I'm assuming that's the logic.
 
I am currently at a hospital that offers patient's nitrous, and I am participating in a multi-center trial looking at the use of nitrous in labor. I personally do not like nitrous. My reasons are that it is bad for the environment and is a teratogen, which of course is not a problem for our patients but it makes me nervous for the nurses and obstetrical residents in the room. However, my participation in this trial involves asking patients to fill out a survey rating their satisfaction with nitrous. And what I have been hearing time and time again is that patients are taught in many of their birthing classes that they should avoid an epidural until their at least 6cm because otherwise the epidural will slow down labor. Of course I know that this is completely untrue. That being said, even though >95% of the patients who use nitrous eventually convert to an epidural they still rate their satisfaction with nitrous very highly, because it is able to take the edge off until they reach 6 cm dilated.

I think this shines light on how anesthesiologist should be more involved in peribirth education. Its very difficult to debunk these myths while patients are writhing in pain, or loopy from nitrous.
 
Whatever the obstetricians want to do for pain control prior to my placing an epidural is up to them.
 
I think it's a great adjunct for a c-section when the mom is wigging out. Give her the mask and tell her to huff on it while daddy is busy playing with baby.

Haven't really seen it used on the floor in our shop though.
 
zzsleepytinizz said:
I am currently at a hospital that offers patient's nitrous, and I am participating in a multi-center trial looking at the use of nitrous in labor. I personally do not like nitrous. My reasons are that it is bad for the environment and is a teratogen, which of course is not a problem for our patients but it makes me nervous for the nurses and obstetrical residents in the room. However, my participation in this trial involves asking patients to fill out a survey rating their satisfaction with nitrous. And what I have been hearing time and time again is that patients are taught in many of their birthing classes that they should avoid an epidural until their at least 6cm because otherwise the epidural will slow down labor. Of course I know that this is completely untrue. That being said, even though >95% of the patients who use nitrous eventually convert to an epidural they still rate their satisfaction with nitrous very highly, because it is able to take the edge off until they reach 6 cm dilated.

I think this shines light on how anesthesiologist should be more involved in peribirth education. Its very difficult to debunk these myths while patients are writhing in pain, or loopy from nitrous.
Click to expand...

There have been quite a few studies on this in the past (names escape me at the moment), and the consensus is that patients using nitrous for labor pain have higher satisfaction scores, but the same VAS pain scores as patients using no analgesics (breathing techniques and other BS).
 
Last edited:
DrZzZz said:
There have been quite a few studies on this in the past (names escape me at the moment), and the consensus is that patient's using nitrous for labor pain have higher satisfaction scores, but the same VAS pain scores as patients using no analgesics (breathing techniques and other BS).
Click to expand...

My satisfaction scores would be higher if I could use nitrous on OB too.
 
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