Schmitt Erica L, Baum Victor C
Department of Anesthesiology, University of Virginia, Charlottesville, Virginia, USA.
Curr Opin Anaesthesiol. 2008 Jun;21(3):356-9. doi: 10.1097/ACO.0b013e3282f8ad76.
Nitrous oxide has been used in clinical practice for over 150 years, often for pediatric procedures. Not only are there problems when used in patients with a variety of inborn errors of metabolism, but effects of nitrous oxide on the developing human brain are unknown.
A recent adult human trial found that the use of nitrous oxide was associated with increased adverse outcome. Animal studies in several species have shown that nitrous oxide can be associated with apoptosis in the developing brain. Nitrous oxide can also inhibit major enzymatic pathways and repeated exposure may lead to neurologic damage. Single nucleotide polymorphisms in at least one of these enzymes are common in the population.
There is a growing body of evidence that supports avoidance of nitrous oxide in both pediatric and adult patients, but the thousands of patients who have been exposed to nitrous oxide without apparent complications would suggest that further studies on long-term side effects and possible neurologic consequences need to be done.
一氧化二氮已在临床实践中使用超过150年，常用于儿科手术。它不仅在患有各种先天性代谢缺陷的患者中使用时存在问题，而且其对发育中的人类大脑的影响尚不清楚。
最近一项针对成年人的人体试验发现，使用一氧化二氮与不良后果增加有关。对多个物种的动物研究表明，一氧化二氮可能与发育中的大脑中的细胞凋亡有关。一氧化二氮还可抑制主要的酶促途径，反复接触可能导致神经损伤。这些酶中至少有一种的单核苷酸多态性在人群中很常见。
越来越多的证据支持在儿科和成年患者中避免使用一氧化二氮，但数以千计接触过一氧化二氮却没有明显并发症的患者表明，需要对长期副作用和可能的神经后果进行进一步研究。
