Will laughing gas have the last laugh?

At a time when the use of laughing gas (nitrous oxide) in clinical practice has gradually reduced, a new article contends that there is 'no clinically relevant evidence' for the withdrawal of nitrous oxide.

The issue whether laughing gas (nitrous oxide) should be banned from the operating room figured prominently in a debate at this year's Euroanaesthesia meeting in Berlin.

"Whereas 30 years ago, nearly every general anaesthesia procedure was performed with nitrous oxide as an adjuvant, a steady decline of its use over the last 15 years has been observed. There are several reasons, which caused the reduction of the usage of nitrous oxide," said Professor Rolf Rossaint from the University Hospital Aachen, Germany, who is in favour of nitrous oxide ban.

Countering his views, Professor Daniel Sessler, Cleveland Clinic, Ohio, US, in his talk on "nitrous oxide is an effective and safe anaesthetic" put forward arguments against a ban.

"There is ... no compelling evidence that nitrous oxide causes important clinical complications. In fact, large randomised trials consistently show that nitrous oxide does not promote complications," Sessler said.

"Nitrous oxide is inexpensive and has favourable kinetics; it does not increase the risk of surgical site infection, post-operative myocardial infarction, or cancer recurrence. And the two complications resulting from nitrous oxide administration, nausea and bowel distension, are minor and no worse than complications caused by alternative anaesthetics," Sessler added.

"There is no clinically relevant evidence for the withdrawal of nitrous oxide from the armamentarium of anaesthesia practice or procedural sedation," said the article published in the European Journal of Anaesthesiology.

The debate coincided with the article published in the European Journal of Anaesthesiology.