The use of nitrous oxide in dermatology and dermatologic surgery is becoming more common. When used correctly and with careful patient monitoring, it is both safe and effective. In my practice, I have used it for simple procedures like a skin biopsy. While excellent topical numbing options exist for pain relief, nitrous oxide is beneficial as an anxiolytic, helping calm patients who are nervous or have a fear of needles.
What Is Nitrous Oxide?
Nitrous oxide is a tasteless gas synthesized and released by cells. When inhaled, it is absorbed into the lungs and diffuses into plasma. In this process, it acts on the central nervous system as both an anxiolytic and analgesic, blocking the NMDA receptor. It has a quick onset of action, short duration, and is easily titrated. It also has a low side effect profile.
Initially used for pain relief during labor in the late 1800s, nitrous oxide is less commonly used for surgical analgesia in the U.S. today. However, it is still widely used in dentistry and pediatrics.
Studies on Nitrous Oxide in Dermatology
A recent review of PubMed and Cochrane databases by Brotzman et al. identified eight studies on the use of nitrous oxide in dermatology. The studies showed that nitrous oxide was effective for providing analgesia during dermatologic procedures, including facial rejuvenation, hair transplantation, and pediatric procedures. Other studies also explored its use in combination with tumescent anesthesia for venous ablation and liposuction. Most adverse effects were temporary and included euphoria, nausea, and dizziness.
Safety and Monitoring
In five of the eight studies, vital signs and oxygen saturation were monitored during inhalation. Nearly all patients maintained adequate oxygen saturation and stable vitals, with a slight increase in blood pressure noted in one study. In four studies, a 50% nitrous oxide/50% oxygen mixture was delivered through an on-demand valve activated by the patient’s breaths to minimize oversedation and prevent hypoxia.
Contraindications
There are some contraindications for using nitrous oxide. It should not be used in pregnant patients, healthcare providers, or assistants. Relative contraindications include nasal obstruction, COPD, active cystic fibrosis, and claustrophobia. According to the National Institute for Occupational Safety and Health, occupational exposure to nitrous oxide may lead to reduced fertility, spontaneous abortion, and neurologic or renal diseases.
The Future of Nitrous Oxide in Dermatology
The majority of studies in the review suggest that nitrous oxide significantly reduces pain during dermatologic procedures. The adverse effects are mild, transient, and dissipate quickly, allowing patients to drive themselves home. However, more research is needed to create clinical guidelines and safety protocols for nitrous oxide use in dermatology. I believe that, once more data is available, nitrous oxide will become a mainstay in analgesia for pediatric, Mohs, and facial rejuvenation procedures.
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