Nitrogen protoxide

Nitrogen protoxide – narcotic drug for inhalation anesthesia.

Form of release and structure

Dosage form – the gas compressed: colourless, can have a slight specific smell, with the non-inflammable, but sustaining combustion property (on 6,2 kg in metal cylinders with a capacity of 10 l).

Active agent – a dinitrogene oxide, in 1 cylinder – 6,2 kg.

Indications to use

Use of Nitrogen of protoxide is shown:

• The inhalation combined anesthesia in combination with narcotic analgetics and muscle relaxants which is carried out on the special equipment;
• The general anesthesia in operational gynecology, the general surgery, stomatology and for a labor pain relief, not demanding muscle relaxation and deep anesthesia;
• Prevention of traumatic shock, and also for strengthening of analgetic and narcotic effect of other medicines, including a medical analgetic anesthesia after surgery;
• Stopping of a pain syndrome at acute pancreatitis, a myocardial infarction, acute coronary insufficiency;
• Shutdown of consciousness for anesthesia at implementation of medical procedures.

Contraindications

• Pathologies of a nervous system;
• Hypoxia;
• Alcoholism or alcohol intoxication;
• Breastfeeding period;
• Hypersensitivity to drug.

With care drug is used at patients with a craniocereberal injury, an intracranial tumor, increase in intracranial pressure in the anamnesis.

In case of need uses during pregnancy drug appoint in small concentration (in a proportion 1:1 to oxygen) to small time (during 2-3 breaths).

Route of administration and dosage

Nitrogen protoxide is applied in the form of inhalation in a combination with oxygen and other anesthetics by means of the special equipment for a gas anesthesia in stationary conditions.

Usually anesthesia begin 70-80% of a dinitrogene of oxide and 20-30% of oxygen with mix with contents.

The recommended concentration of a dinitrogene of oxide:

• Medical anesthesia during the stopping and prevention of a pain syndrome: 40-75%;
• General anesthesia: a dose for bystry immersion on the necessary depth of an anesthesia – 70-75%, a maintenance dose – 40-50%. In case of need it is possible to add powerful narcotic drugs to mix, including Ftorotanum, barbiturates, ether. After shutdown of giving of a dinitrogene of oxide, 4-5 more minutes, for the purpose of prevention of a diffusion hypoxia are recommended to continue supply of oxygen;
• Labor pain relief: 40-75%, using a method of a discontinuous autoanalgeziya at which the woman in labor begins mix inhalation at emergence of harbingers of a fight and stops at its peak or to the end of a fight;
• Shutdown of consciousness for implementation of medical procedures: 25-50%.

For children concentration of drug are selected individually, at the same time the content of oxygen in mix has to make 30% and more. After end of anesthesia it is necessary to continue inhalation supply of oxygen within 5 minutes for prevention of a hypoxia.

Inhalation anesthesia is carried out against the background of premedication. For the purpose of the prevention of nausea and vomiting, for decrease in contagious excitation and strengthening of action intramuscular introduction of 2-3 ml of 0,25% of solution of Droperidolum (5-7,5 mg), 1-2 ml of 0,5% of solution of diazepam (5-10 mg) is shown.

Side effects

Use of Nitrogen of protoxide can cause side effects in the form of bradycardia, supraventricular arrhythmias, a circulatory unefficiency – during introduction of the patient to a condition of the general anesthesia.

Undesirable effects after an exit from an anesthesia can become: drowsiness, nausea, vomiting, diffusion hypoxia, confusion of consciousness, feeling of alarm, excitement, nervousness, hallucinations, motive excitement. Long use (2 and more than a day) can lead to respiratory depression, dysfunction of marrow (a leukopenia, pancytopenias), to cause a postoperative fever and hyper thermal crisis.

Special instructions

Use of drug needs to be accompanied with control of arterial pressure, heart rate (HR), a cordial rhythm, and also to watch a condition of gas exchange and breath, body temperature of the patient. During an anesthesia it is recommended to pump out periodically gas from a cuff of an endotracheal tube.

Use of Nitrogen of protoxide is shown at treatment of children of chest and advanced age. It is impossible to appoint drug newborn.

The long contact with drug at medical personnel increases risk of development of a leukopenia.

Certain concentration of mix with cyclopropane, ether, Aether chloratus are explosive.

Patients with an alcoholism require purpose of high concentration of a dinitrogene of oxide.

Drug is not used at control of vehicles and mechanisms.

Medicinal interaction

At simultaneous use of Nitrogen of protoxide:

• Amiodaronum – increases probability of arterial hypotension and the bradycardia which is not stopped by atropine;
• Fentanyl and its derivatives – strengthen influence on cardiovascular system, promote decrease in minute volume of heart and ChSS;
• Xanthines – increase risk of arrhythmias;
• Tranquilizers, means for inhalation anesthesia, neuroleptics, narcotic analgetics, antihistaminic drugs – strengthen action.

At a combination drug strengthens effects of diazoxide, ganglioblokator, diuretics, derivative coumarin and the indandion, means oppressing a nervous system and breath.

Terms and storage conditions

To store at a temperature up to 25 °C. To protect from children.

Period of validity – 5 years.