200 years of nitrous oxide (laughing gas)--and the end of an era?

The history of nitrous oxide is more than 200 years old and its clinical use as anaesthetic is more than 150 years old. The symposium discussed the question whether nitrous oxide should maintain its traditional role as a component of the anaesthetic breathing gas in everdays anaesthetic procedure or whether there are indications not to continue the regular use of nitrous oxide. As a matter of fact the continued use of nitrous oxide will not change its clinical pharmacology and one may argue that every year of additional experience with this drug is likely to increase the safety of its application. However, one has steadily to judge the risks of this drug against its alternatives and these have changed dramatically over the past decades. The new anaesthesia machines allow the combination of oxygen and air as breathing gas, there are new inhalational agents (e. g. desflurane, xenon) as controllable as nitrous oxide and new i. v. agents. As a conclusion of these developments the Department of Anaesthesiology at the Universität Erlangen-Nürnberg has decided to cease the traditional use of nitrous oxide.