Nitrous oxide-based techniques versus nitrous oxide-free techniques for general anaesthesia

Nitrous oxide continues to be commonly used in combination with oxygen and volatile / intravenous anaesthetic agents to provide anaesthesia for adults undergoing surgery. There is sound evidence identifying benefits for the use of nitrous oxide such as enabling the reduction of volatile and intravenous anaesthetic agents required to achieve adequate anaesthesia and therefore risk from those agents, as well as facilitating rapid onset and emergence from anaesthesia. However, the advantages must be balanced against known disadvantages of use including, the risk of impaired cognition, postoperative nausea and vomiting, and the potential for a resulting immunocompromised patient. These complications must be managed by the perioperative care team prior to the patient being transferred back to the nursing ward. As evidence has increased surrounding the adverse effects of nitrous oxide being used as part of an anaesthetic technique, its continued use in anaesthesia has been questioned. Therefore, this review shall inform nurses in perioperative care and on wards to better understand the patient effects of nitrous oxide use and better inform the care delivered to these patients.