Safety and Risk of Nitrous Dioxide during Labor - Literature review Example

Safety and Risk of Nitrous Dioxide during Labor State of the Science paper Abstract Background: Nitrous Oxide, N­2O, is an analgesia that is used in labor. In this analgesic, N2O and O2 are mixed in 50/50 ratio, and the mother in labor preferably self-administers the analgesic. Problem: Concerns have been raised in regards to the effect of N­2O on the brains of immature mammals. This risk is presented in the event of exposure to high doses of the analgesia during late gestation. There have also been claims that nitrous oxide analgesia poses cardiovascular risks due to hyperhomocysteinemia. Children who are exposed to nitrous oxide, N­2O during birth have increased chances of becoming addicted to amphetamine drugs in adulthood. In addition to these risks, N­2O poses occupational risk to those administering it. Purpose: This author intends to examine the evidence that has been advanced concerning the use of N­2O analgesia during labor. The risks that are associated with N­2O use during labor will be analyzed. The safety precautions to be observed when using this method will also be examined. In so doing, a balance will be established, at how the method can be used with minimal risks to concerned parties. This author intends to combine information from a variety of current literature, in order to understand the effects N2O/O2 analgesic has when used in labor. Methods: In this paper, seven literature sources from recent times are examined for evidence of effects of Nitrous Oxide use in labor. Key terms used in the search summary include Nitrous Oxide analgesia, labor analgesia, risks and benefits of Nitrous oxide in labor, and effects of Nitrous Oxide use in labor. The evidence used in this analysis was obtained through American Society of Anesthesiologists site, and current print material. Introduction Nitrous Oxide is a chemical compound with the formula N­2O and is an oxide of Nitrogen. This gas is commonly referred to as ‘sweet air’ or ‘laughing gas.’ Inhaling it has a euphoric effect, and this was the motivation behind its use as an analgesia (Schaefer, Peters, & Miller, 2007). Since the inception of N­2­­O analgesia use in the management of pain during labor, studies have been conducted to ascertain the various effects it has, other than the analgesic property. In the United States, the reported use of N­2O as a labor analgesia is a minimal 1%. This is the motivation of this review. It is an analysis of the factors that have led to the decreased, to almost nil use of N­2O analgesia during labor. When used in high doses, N­2O is a weak anesthetic but, in low doses, it is an analgesic. The low dose use of N­2O is achieved by using it in 50/50 combination with oxygen gas. When the50% N­2O is in Oxygen, the mixture is referred to as Entonox. Concerns that have been advanced are in relation to the effect that Entonox has on labor, and birth. Studies have also indicated that N­2O analgesia during labor affects breastfeeding, and the wellbeing of both mother and neonate. There are also possible occupational risks that this method presents to persons who care for mothers during labor. Reviews on the occupational risks and the safety of N­2O labor analgesia have also been carried out. It is essential for a nurse to be well aware of the risks linked to this method in order to practice safety precaution. This knowledge also makes it possible for the nurse to provide the mother with proper care during labor. Rationale of Use The use of N­2O was recommended earlier, due to its low blood-gas solubility coefficient. The value of 0.47 is indicative of its ability to rapidly equilibrate with blood. When used during labor to manage pain, N­2O is used intermittently, targeting the peak pain during contractions. The parturient can be trained on how to effectively time peak contraction pain (Curtis Baysinger). To attain near-maximum effect of Entonox, approximately ten breaths are required. The intermittent use ensures that there is minimal accumulation of N­2O in blood during, and after use. It is also rapidly washed out of the lungs. Relevance to Nursing Nursing is a people-centered profession that aims at helping persons recover, attain, or maintain best possible health and life quality from their time of conception to death. Factors that affect maternal and child health are very important in the determination of the care plan to be used during delivery and labor. In the United States, improving well-being of mothers is a chief public health goal in the Healthy People 2020 program. For a nurse to participate in the achievement of this objective, it is imperative to understand the pros and cons of the different analgesics used during labor. Statistics of Use and Analysis Since 1880, N­2O mixture with Oxygen has featured greatly in obstetric practice. Since the self-administration apparatus was introduced in 1934, N­2O use for labor analgesic became routine procedure (Rooks J. P., 2011). It has wide use in developed countries, but much less in developing countries. The almost non-existent use in developing countries is due to financial constraints. This, however, cannot be attributed for the minimal use in the United States. In the United States, only two centers have been identified that use N­2O for labor analgesia routinely. This translates to 1% on women in America using this method. The statistics recorded in the United States are a far-removed contrast from the situation in neighboring developed countries. In the United Kingdom, 60% of laboring women use this technique. Australia reports use of the technique by 50% of laboring women. The use of N­2O analgesic is routine for close to 50% laboring women in Finland and Canada. This disparity of use between the United States and other nations that are developed begs for an explanation (Schaefer, Peters, & Miller, 2007). Safety The major benefit of using N­2O is that it relieves the pain experienced during labor, helping the woman to cope better. N­2O analgesia does not affect the alertness and responsiveness of either mother or new-born, after birth. This is crucial since immediate moments after birth are vital for mother-child bonding. The risk of respiratory depression is not increased with the use of N­2O analgesia. N­2O when administered to the mother reaches the fetus through the placenta (Rooks J. , 2010). Through the mother’s respiratory function, however, a part of it is eliminated. The amount that remains in fetal circulation is immediately removed by neonatal respiration as soon as the child begins to breath. Associated Risks The negative effects of N­2O use for management of labor pain vary from mild ones, to those that are severe and long-term. They can also be to the mother, the fetus, or to the person taking care of the mother as labor progresses. For the mother, this technique may induce nausea during labor (CHILDBIRTH CONNECTION, 2006). N­2O may also cause maternal oxygen desaturation rate to increase during labor. This is because N­2O has a direct respiratory depressant effect that which worsens maternal hypocapnia that accompanies labor. 0 – 24% of the women who use this technique report drowsiness. This might affect the labor process since when the laboring woman is required to push; she might lack the sufficient energy to do so. Cases of maternal unconsciousness have also been reported, but these are dose dependent; 1% with 50% N­2O being used, and 5% with 80% use of N­2O. In 1987, a group of investigators from Karolinska Institute published the first paper that was in support of the hypothesis that; the analgesic drugs administered in late gestation are linked to the increased risk of self-destructive behavior and drug addiction of the child later in life. Studies proved that this hypothesis was true, and was dependent on the dose of the analgesic administered in the 10 hours preceding birth. This risk was attributed to neurological “imprinting.” When administered, N­2O concentration in fetal blood is about 80% of the concentration in maternal circulation (Murray & Huelsmann, 2008). No effect is reported on the fetal heart rate. When the neonate starts breathing, the N­2O is rapidly eliminated by the lungs, and no depression is experienced on respiratory function. The effect of exposure to N­2O in utero on human fetuses is, therefore, unknown. Those taking care of laboring women usually experience long-term exposure to N­2O when it is being used routinely. Effects of long-term exposure are unknown, although there are suspicions of adverse reproductive outcomes for persons taking care of these caregivers. Conclusion The major benefit of using N­2O during labor is that it reduces the anxiety and pain that accompanies the process. There are no known adverse outcomes for the fetus, neonate, or the mother. Uterine contractility is not affected in any manner since pituitary gland release of oxytocin is unaffected. The risks that are associated with using N­2O analgesic during labor cannot be termed adverse. The safety of the laboring woman, the fetus, or mother after delivery, is not compromised. The risks are manageable, making the use of N­2O analgesic a safe option for fetus, neonate, and mother. This procedure can also be made safe for the caregivers. By letting the laboring woman to self-administer the N­2O, using N­2O in 50% mixture with Oxygen and practicing good occupational hygiene, the technique is made safe for care-givers (Zimmerman, 2010). It is necessary to note that the safety, risks, and efficiency of N­2O use are all wholly dependent on the dose. References CHILDBIRTH CONNECTION. (2006, August 6). Labor Pain - Nitrous oxide. Retrieved January 31, 2012, from CHILDBIRTH CONNECTION: http://www.childbirthconnection.org/article.asp?ck=10188 Curtis Baysinger, M. (n.d.). Nitrous Oxide for Labor Analgesia. Retrieved January 31, 2012, from American Society of Anesthesiologists: http://www.asahq.org/For -Members/Clinical-Information/Nitrous-Oxide.aspx Murray, M., & Huelsmann, G. (2008). Labor and delivery nursing: a guide to evidence-based practice. New York: Springer Publishing Company. Rooks, J. (2010, April 25). Consider the Source: An Interview about Nitrous Oxide with Judith Rooks. (S. &. Sensibility, Interviewer) Rooks, J. P. (2011). Safety and Risks of Nitrous Oxide Labour Analgesia: A Review. Journal of Midwifery & Women's Health , 557 - 565. Schaefer, C., Peters, P. W., & Miller, R. K. (2007). Drugs during pregnancy and lactation: treatment options and risk assessment. San Diego: Academic Press. Zimmerman, R. (2010, September 6). Laughing Gas For Labor Pain — Why Not? Retrieved January 31, 2011, from CommonHealth Reform And Reality: http://commonhealth.wbur.org/2010/09/nitrous-oxide-childbirth-pain/ Read More