Nitrous Oxide Safety and Side Effects

Introduction to Nitrous Oxide Risks

Nitrous oxide can cause significant side effects, including dizziness, drowsiness, vitamin B12 deficiency leading to neurological damage, and potential asphyxiation risk, with the most common immediate side effect being dizziness affecting up to 39% of users 1

The American Thorax Society recommends that nitrous oxide should be avoided in patients with known emphysema, as well as those at risk of hypercapnic respiratory failure 1

The American Thorax Society recommends monitoring with pulse oximetry when nitrous oxide is used medically, and to always co-administer with supplemental oxygen to avoid hypoxia 1
Co-administration of nitrous oxide with 30-50% oxygen is recommended by the American Gastroenterological Association (AGA) Institute and the Multisociety Sedation Curriculum for Gastrointestinal Endoscopy to avoid hypoxia 2, 3
Lack of oxygen supplementation during medical use of nitrous oxide increases the risk of side effects, according to the American Thorax Society 1

Headaches are a known side effect of nitrous oxide, documented in multiple clinical studies and guidelines, according to the American Gastroenterological Association (AGA) Institute and the Multisociety Sedation Curriculum for Gastrointestinal Endoscopy 2, 3
Other adverse effects may include hypertension, arrhythmias, nausea, and vomiting, according to the American Gastroenterological Association (AGA) Institute and the Multisociety Sedation Curriculum for Gastrointestinal Endoscopy 2, 3
Patients with longer duration of exposure to nitrous oxide and those undergoing procedures where nitrous oxide is used for sedation are at higher risk for nitrous oxide-induced headaches 2, 3

While nitrous oxide offers advantages of rapid onset and recovery, the headache side effect may impact patient satisfaction, as noted by the American Gastroenterological Association (AGA) Institute 2