Nitrous oxide use in paediatric surgery

Nitrous oxide (N2O) has several appealing pharmacological characteristics that have made it the most widely used inhalational anaesthetic. It has a particularly strong foothold in paediatric anaesthesia. Both its uptake and elimination are rapid due to its low blood:gas solubility coefficient, which makes it suitable for paediatric ambulatory surgery. It is moderately effective, although when used alone it is not a complete anaesthetic. It also shows moderate analgesic action. N2O has little, if any, cardiorespiratory effect in children unless it is combined with volatile anaesthetics. The major concerns of its wide use are mostly environmental and related to personnel and patient safety, since it may induce myelopathy and suppress bone marrow. However, a safer, more effective or cheaper substitute for N2O for anaesthetic maintenance has yet to be introduced in paediatric anaesthesia.