Nitrous oxide

Nitrous oxide (N2O) is an inhalational gas used in combination with oxygen to carry volatile anaesthetic agents (such as isoflurane) for the induction and maintenance of general anaesthesia. It reduces the required concentration of the primary inhalant agent and hastens the attainment of a stable anaesthetic plane via the **second gas effect** and **concentration effect**. > **Clinical Warning:** N2O will cause a rapid expansion of any gas-filled space, increasing volume or pressure. It is strictly contraindicated in patients with pneumothorax or gastric dilatation-volvulus (GDV). > **Clinical Warning:** Oxygen must be supplemented for 5-10 minutes after N2O is discontinued to prevent **diffusion hypoxia**.

กลไกการออกฤทธิ์: Nitrous oxide causes generalized **CNS depression**. When administered at the beginning of volatile agent anaesthesia, it increases the speed of uptake of the volatile agent from the alveoli → **second gas effect** and **concentration effect** → hastens attainment of a stable plane of anaesthesia. It has minimal direct respiratory and cardiovascular effects.

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