Establishing a health-based recommended occupational exposure limit for nitrous oxide using experimental animal data - A systematic review protocol.

Nitrous oxide (N 2 O) is widely used as inhalation analgesic and anaesthetic in medical, paramedical, and veterinary practice. Previous evaluations resulted in classification of N 2 O as a possible risk factor for adverse reproductive health outcomes based on evidence from animal data. Available human data were considered inadequate, partly due to the possibility that other risk factors, such as co-exposures to other inhalation anaesthetics may have contributed to the adverse outcomes. As no substantial new human evidence has emerged since previous evaluations, this protocol describes a planned systematic review of the evidence obtained from animal studies. The aim is to assess the available evidence on the effects of N 2 O on reproductive and developmental outcomes in animals to inform a health-based recommended occupational exposure limit (OEL) for N 2 O. Comprehensive search strategies were designed to retrieve animal studies addressing N 2 O exposure from PubMed, EMBASE, and Web of Science. Screening of the studies retrieved will be performed by at least two independent reviewers, while discrepancies will be resolved by reaching consensus through repeated review and discussions. Articles will be included according to criteria specified in this protocol. Outcome data relevant for reproduction and development will be extracted and risk of bias will be assessed by two independent reviewers using the SYRCLE's risk of bias tool. Primary reproductive and developmental outcomes of interest will be the number of resorptions, malformations, and birth weight. We will focus on dose-response studies that allow to derive an OEL with the benchmark dose (BMD) approach. Adverse outcomes occurring at doses that are equivalent to the exposures occurring in human occupational settings will be particularly relevant for dose-response modelling. The proposed review has not been performed before. We will follow the procedures specified in this protocol. We will adhere to guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), adapted for animal studies. Ethical approval will not be required, as the review will use existing data available in the public domain.

BET 1: Green or blue for you? Methoxyflurane (Penthrox) or nitrous oxide/oxygen 50% mixture (Entonox) for the management of acute pain in the ED.

A short-cut review of the literature was carried out to establish whether inhaled methoxyflurane (Penthrox) is comparable or superior with a standard inhalational analgesia for the management of acute pain. Only two papers were identified as suitable for inclusion using the reported search strategy. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the best papers are tabulated. It is concluded that both methods of inhaled analgesia appear to be useful options for acute pain in the ED when compared with placebo. No evidence was found to suggest superiority of methoxypenflurane. International studies directly comparing the use of both drugs for in acute trauma are ongoing and will develop the evidence base.

A study on the evaluations of emission factors and uncertainty ranges for methane and nitrous oxide from combined-cycle power plant in Korea.

In this research, in order to develop technology/country-specific emission factors of methane (CH(4)) and nitrous oxide (N(2)O), a total of 585 samples from eight gas-fired turbine combined cycle (GTCC) power plants were measured and analyzed. The research found that the emission factor for CH(4) stood at "0.82 kg/TJ", which was an 18 % lower than the emission factor for liquefied natural gas (LNG) GTCC "1 kg/TJ" presented by Intergovernmental Panel on Climate Change (IPCC). The result was 8 % up when compared with the emission factor of Japan which stands at "0.75 kg/TJ". The emission factor for N(2)O was "0.65 kg/TJ", which is significantly lower than "3 kg/TJ" of the emission factor for LNG GTCC presented by IPCC, but over six times higher than the default N(2)O emission factor of LNG. The evaluation of uncertainty was conducted based on the estimated non-CO(2) emission factors, and the ranges of uncertainty for CH(4) and N(2)O were between -12.96 and +13.89 %, and -11.43 and +12.86 %, respectively, which is significantly lower than uncertainties presented by IPCC. These differences proved that non-CO(2) emissions can change depending on combustion technologies; therefore, it is vital to establish country/technology-specific emission factors.

Development of methane and nitrous oxide emission factors for the biomass fired circulating fluidized bed combustion power plant.

This study makes use of this distinction to analyze the exhaust gas concentration and fuel of the circulating fluidized bed (CFB) boiler that mainly uses wood biomass, and to develop the emission factors of Methane (CH(4)), Nitrous oxide (N(2)O). The fuels used as energy sources in the subject working sites are Wood Chip Fuel (WCF), RDF and Refused Plastic Fuel (RPF) of which heating values are 11.9 TJ/Gg, 17.1 TJ/Gg, and 31.2 TJ/Gg, respectively. The average concentrations of CH(4) and N(2)O were measured to be 2.78 ppm and 7.68 ppm, respectively. The analyzed values and data collected from the field survey were used to calculate the emission factor of CH(4) and N(2)O exhausted from the CFB boiler. As a result, the emission factors of CH(4) and N(2)O are 1.4 kg/TJ (0.9-1.9 kg/TJ) and 4.0 kg/TJ (2.9-5.3 kg/TJ) within a 95% confidence interval. Biomass combined with the combustion technology for the CFB boiler proved to be more effective in reducing the N(2)O emission, compared to the emission factor of the CFB boiler using fossil fuel.

Safety and risks of nitrous oxide labor analgesia: a review.

INTRODUCTION: This review of the safety and risks of nitrous oxide (N(2) O) labor analgesia presents results of a search for evidence of its effects on labor, the mother, the fetus, the neonate, breastfeeding, and maternal-infant bonding. Concerns about apoptotic damage to the brains of immature mammals exposed to high doses of N(2) O during late gestation, possible cardiovascular risks from hyperhomocysteinemia caused by N(2) O, a hypothesis that children exposed to N(2) O during birth are more likely to become addicted to amphetamine drugs as adults, and possible occupational risks for those who provide care to women using N(2) O/O(2) labor analgesia are discussed in detail. METHODS: Research relevant to the 4 special concerns and to the effects of N(2) O analgesia on labor and the mother-child dyad were examined in depth. Three recent reviews of the biologic, toxicologic, anesthetic, analgesic, and anxiolytic effects of N(2) O; 3 reviews of the safety of 50% N(2) O/oxygen (O(2) ) in providing analgesia in a variety of health care settings; and a 2002 systematic review of N(2) O/O(2) labor analgesia were used. RESULTS: Nitrous oxide analgesia is safe for mothers, neonates, and those who care for women during childbirth if the N(2) O is delivered as a 50% blend with O(2) , is self-administered, and good occupational hygiene is practiced. Because of the strong correlation between dose and harm from exposure to N(2) O, concerns based on effects of long exposure to high anesthetic-level doses of N(2) O have only tenuous, hypothetical pertinence to the safety of N(2) O/O(2) labor analgesia. DISCUSSION: Nitrous oxide labor analgesia is safe for the mother, fetus, and neonate and can be made safe for caregivers. It is simple to administer, does not interfere with the release and function of endogenous oxytocin, and has no adverse effects on the normal physiology and progress of labor.

Comparison of two techniques of narcotic-induced anesthesia for use during recording of magnetic motor evoked potentials in dogs.

OBJECTIVE: To compare 2 types of narcotic-induced anesthesia for recording of transcranial magnetic motor evoked potentials (TMMEP) in dogs. DESIGN: The effect of different doses of sufentanil and midazolam and of sufentanil and nitrous oxide on onset latencies and peak-to-peak, amplitudes of TMMEP was evaluated and compared. ANIMALS: 18 neurologically normal dogs. PROCEDURE: Premedication with droperidol and fentanyl. Induction and maintenance of anesthesia either with sufentanil and midazolam or with sufentanil and nitrous oxide. Recording of TMMEP from the extensor carpi radialis muscle of the forelimb and from the cranial tibial muscle of the hind limb. RESULTS: Both types of narcotic anesthesia induced dose-dependent suppression of TMMEP; compared with baseline recordings, latencies increased, amplitudes decreased, and reproducibility became poorer with increasing dose of the anesthetics. Using surgical-depth doses of the anesthetics, TMMEP could still be recorded in all dogs with sufentanil and nitrous oxide, but not with sufentanil and midazolam anesthesia. CONCLUSIONS: Sufentanil and nitrous oxide anesthesia was superior to sufentanil and midazolam anesthesia for TMMEP recording. CLINICAL RELEVANCE: In small animal medicine, and in dogs in particular, spinal cord diseases are among the most frequently encountered neurologic disorders. The development of techniques for recording TMMEP in anesthetized dogs allows noninvasive evaluation of transmission along descending motor pathways of the spinal cord.

[Use of the "exposure level-body condition" relations for evaluation of the effects of complex atmospheric pollution]. / Ispol'zovanie zavisimosti "kontsentratsiia-status organizma" dlia otsenki vozdeistviia kompleksa atmosfernykh zagriaznenii.

Criteria for the organism status arrangement in terms of environmental effects expression from adaptation to its break-down were worked up. The criteria may be used in developing of the hygienic standardization of environmental effects.

[Pollution of operating rooms. Measurements made during five anesthesias]. / Pollution des blocs opératoires. Measures effectuées lors de cinq anesthésies.

The purpose of this study is to measure amounts of anaesthetic vapours present in operating rooms and anaesthetic places without any gas scavenging system except air conditioning with fifteen air changes per hour. Nitrous oxide, halothane and isoflurane were measured. Halothane and isoflurane concentration is slightly higher than the French standard for anaesthetic places and lower for operating rooms. Nitrous oxide concentration is five to eight times greater than recommended standard. Although no international agreement exists concerning an acceptable pollution standard, it seems that only nitrous oxide pollution is disquieting. It would seem sensible to avoid needles contamination by use of waste gas scavenging devices.

The nonlinear potency of sub-MAC concentrations of nitrous oxide in decreasing the anesthetic requirement of enflurane, halothane, and isoflurane in rats.

The effect of nitrous oxide (N2O) on the MAC of enflurane, halothane, and isoflurane was determined in male rats. Each rat received either enflurane, halothane, or isoflurane, along with 0%, 15%, or 75% N2O. Anesthetic equilibration was verified by mass spectrometry sampling of end-tidal gases. MAC was determined at each N2O concentration by the standard tail clamp method. The N2O dose-response data for each animal were fit by a second-order polynomial equation to estimate the value of a second-order coefficient. A linear dose-response would result in a value of zero, whereas the extent to which the data deviate from nonlinearity would be reflected by an increase in the value of this coefficient. The null hypothesis, that the second-order coefficient should be zero, was tested by a one-sample two-tailed t test. The volatile anesthetic requirement decreased as the N2O concentration increased; however, it did not do so linearly. For each of the three volatile anesthetic groups, the second-order coefficients were consistently greater than zero (P less than 0.05). These data are not consistent with the accepted presumption that the summation of N2O with volatile anesthetics is linear.