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Nitrous Oxide Issue Toolkit

Background | Resources | Articles

 


 

 

Background

In 1994, the National Institute for Occupational Safety and Health (NIOSH) has issued a warning to the hundreds of thousands of medical, dental, and veterinary professionals who work with nitrous oxide (N2O). The Institute warned that even with preventive measures such as scavenging systems in place these workers may be at risk for serious health effects due to their exposure.

N2O, commonly called laughing gas, is an anesthetic agent used in operating rooms. Workers are exposed to N2O while administering the anesthetic gas to patients. To protect workers from the health risks associated with N2O, operating rooms are often equipped with scavenging systems that vent unused and exhaled gas away from the work area. Research has shown that these systems can significantly reduce the risk of impaired fertility among female dental assistants exposed to N2O.

However, a NIOSH Alert reports that even with scavenging systems in place, Institute researchers measured N2O exposures as high as 12 times the NIOSH recommended limit in hospital operating rooms and more than 40 times the NIOSH recommended limit in dental operating rooms. The report clearly demonstrates that simply using a system is not sufficient--it must be continuously monitored and maintained to effectively reduce exposure to N2O.

Several human studies have shown that occupational exposure to N2O may cause reduced fertility, spontaneous abortions, and neurologic, renal, and liver disease as well as documented decreases in mental performance, audiovisual ability, and manual dexterity. Moreover, animal studies have shown that exposure to N2O during gestation can produce adverse health effects in offspring.

The NIOSH Alert, Request for Assistance in Controlling Exposures to Nitrous Oxide During Anesthetic Administration, warns workers of the hazards of N2O exposure and provides prevention measures. A summary of the guidelines for controlling exposure to N2O is provided on the following page. Although properly operating scavenging systems have been shown to reduce N2O concentrations by more than 70%, simply having a scavenging system in place is not enough. Workers and employers must ensure that systems and equipment are properly operated, inspected, and maintained. NIOSH urgently requests your assistance in informing all workers of the hazards they face if exposed to N2O at their workplace.

(Source: NIOSH)

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Resources

NIOSH
Control of Nitrous Oxide in Dental Operatories
Dental workers are exposed to Nitrous Oxide (N2O) during administration of this anesthetic gas to patients. Exposures should be minimized to prevent short-term behavioral and long-term reproductive health effects that can be produced by N2O.
NIOSH
Nitrous Oxide
NIOSH resources.

OSHA
Occupational Safety and Health Guidelines for Nitrous Oxide

This guideline summarizes pertinent information about nitrous oxide for workers and employers as well as for physicians, industrial hygienists, and other occupational safety and health professionals who may need such information to conduct effective occupational safety and health programs. Recommendations may be superseded by new developments in these fields; readers are therefore advised to regard these recommendations as general guidelines and to determine whether new information is available.
OSHA
Anesthetic Gases: Guidelines for Workplace Exposures
The guidelines are advisory in nature, informational in content, and are intended to assist employers in providing a safe and healthful workplace through effective prevention programs adapted to the needs of each place of employment.
NLM (Hazardous Substance Data Bank): Nitrous OxideInformation regarding human health effects.
Anesthesia for the Dental VisitFor the dental patient.
Nitrous OxideFrom the American Academy of Pediatric Dentistry.
Guideline on use of nitrous oxide for pediatric dental patients.Guideline on use of nitrous oxide for pediatric dental patients.

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Articles

Nitrous oxide and oxygen sedation: an update It is necessary to educate the entire office team on the biohazard issues of nitrous oxide safety in the dental office and keep abreast of sound scientific literature in this area. Many states are starting to include nitrous oxide administration and monitoring in their state practice acts for dental assistants. Refer to your state practice act for current requirements in your location.
Australian Study Evaluates Nitrous Oxide Safety for Patients Undergoing Major Surgery In a randomized clinical trial by an Australian research team, adult patients who received nitrous oxide during major surgery were at increased risk of postoperative complications, including pneumonia, fever, severe nausea and wound infection.
Evaluation of two nitrous oxide scavenging systems using infrared thermography to visualize and control emissionsThe authors conducted a study to determine the effectiveness of two waste anesthetic gas-scavenging systems. They also evaluated one of the systems to determine the effect of work practices in controlling waste nitrous oxide (N2O).
How American dentists helped pioneer oxygenation of general anesthetics worldwideDentists Horace Wells and later William Morton introduced the world to general anesthesia with nitrous oxide and ether, respectively.
Nitrous oxide and the inhalation anestheticsThe purpose of this CE article is to provide an overview of inhalation anesthetics in general and to address nitrous oxide more specifically in comparison.

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