Why is entonox not available in the US and some European countries?

[BumgrapesofWrath]

Just curious really!

I'm due to have DC2 within the next few weeks, and I'll be relying on gas and air I'm sure! So I just wondered why it isn't available in other countries (I only know this from reading threads on here).

I have low bp and the gas and air made my bp drop more and too much made me faint - which removed the pain which came back gradually as I came round! It was amazing, after that I learned how I could take enough to get to almost fainting but not pass out which really helped the pain - perhaps people with higher bp would find little affect?

That's interesting Princess as I have low blood pressure in pregnancy and I found it very effective.

Didn't do anything for me in terms of pain relief but it made me breathe deeply (like yoga breathing) and when I tried to breathe through a contraction without it I failed miserably and panicked. I don't know how I'd have managed without it. I even had it (through a mask though) in theatre while they were siting my spinal block.

I thought it was brilliant, adn was harping on to the MW about how she should set up a pub where you could sit in warm water whilst having G&A. Got almost to the point of pushing with just that, then had morphine.

I had no idea that it wasn't available in some countries. It's quite widely used in the UK isn't it? Are you ladies in France saying that you can't have morphine/pethedine either?

That's right Visualiseahorse, I'm in France and it's an epidural or nothing. The care I received was exceptional and my birth experience a million times better than in the UK but it is very medicalised so if you're a water birth and whale music kinda gal then France wouldn't be ideal. I loved it.....why suffer in pain?? My medical team here were horrified when I told them I hadn't had an epidural first time and when I tried to explain that I'd had G&A and pethidine...they didn't understand what I meant.....although that could be my terrible French!!

I live in the UK but agree with the French attitude femmeeaufoyer Is it only us crazy English who want to suffer and think an epidural is failure/terrible? Having said that, even though I want strong pain relief I think the water birth/whale music/homebirth people should have the right to do that if that is what they prefer. I have heard a very small percentage of women are lucky enough not to suffer as much with labour pains.....not sure if this is true.

I don't like that there is no middle ground in France. In my case (where I wanted as natural birth as possible, epidural was the last thing on my list) would mean that I would've had to go to the big hospital instead of using the local birthing unit. I used G&A most of the way and morphine at the very end. By using this it meant I could be mobile all the time, and straight away after, and go home within 4 hours of birth.

Sorry, missed this bit on the end...
It meant I had more control over what was happening, and although the pain was horrific, for me, that pain (for me) is important in some respects.

For the Frenchies...I thought that my hospital didn't offer G&A until I spoke specifically about this to my midwife last week about it. It turns out my local (pretty small) hospital does do it though in my last pregnancy they never mentioned it. It's known as MEOPA and the midwife says she has English girls all the time mimicking the mask on face gesture for their gas because they don't know the word for it .

Don't know if this review undertaken at Imperial college in 2008 by Sanders and Weimann helps:

"Nitrous oxide is the longest serving member of the anesthesiologist's pharmacologic armamentarium but remains a source of controversy because of fears over its adverse effects. Recently, the Evaluation of Nitrous oxide In a Gas Mixture for Anaesthesia (ENIGMA) trial reported that nitrous oxide use increases postoperative complications; further preclinical reports have suggested that nitrous oxide may contribute to neurocognitive dysfunction in the young and elderly. Therefore, nitrous oxide's longevity in anesthetic practice is under threat. In this article, the authors discuss the evidence for the putative toxicity of nitrous oxide, from either patient or occupational exposure, within the context of the mechanism of nitrous oxide's action. Although it would seem prudent to avoid nitrous oxide in certain vulnerable populations, current evidence in support of a more widespread prescription from clinical practice is unconvincing."

Interesting about the pros and cons. I found it took the edge off the pain but I forgot where I was and what was happening, and it is quite distressing to be in loads of pain and have no idea why - I felt like a wounded animal

There isn't any scavenging device used in the labour rooms where I work. I'm worried now about my long term exposure to it!

onlinelibrary.wiley.com/doi/10.1111/j.1751-486X.2012.01763.x/full

That is a very interesting article about the use of gas and air :)

Ushy -

There are two major differences in what the article you referenced is discussing versus how nitrous oxide (and oxygen) are used during labor. The differences are Anesthesia versus Analgesia (pain managment) and administering "only" Nitrous Oxide versus a combination of Nitrous Oxide and Oxygen.

This topic is often confused - and is a completely different use for a different application. The article referenced covers the use of Nitrous Oxide as an Anesthetic agent, administered at 100%, and for long durations.

Nitrous Oxide (N20) used as a single agent (100% N20) can achieve general anesthesia on a patient. This is very rarely used anymore in most countries - and not used in the U.S. as anesthesia.

The combination of Nitrous Oxide and Oxygen (02) - is used very frequently as an analgesic and sometimes for minimal sedation (patient is awake, alert, responsive, etc) - such as in the dental office or in the hospital during labor - for brief periods of time. For labor applications the typical "mix" is 50% N20 and 50% 02. The patient is actually receiving a higher concentration of 02 than what they are breathing in room air.

The confusion sometimes comes from how we talk about N20. You often hear someone say "I was at the dentist and they gave me nitrous oxide". Actually - they were getting both Nitrous Oxide and Oxygen. All modern delivery systems here in the US (and most of the world) cannot deliver N20 without 02. In fact - most systems are designed to automatically shut off if the 02 supply runs out.

Hope that helps clarify a sometimes confusing topic!

Here is another great article that was published last month on N20/02 use for labor:

www.porterinstrument.com/dentalcontent/files/datasheets/Nitrous-Oxide-as-Labor-Analgesia-Clinical-Implications-for-Nurses.pdf

There are also a couple of You Tube videos of patient use of Nitronox on our website: www.porterinstrument.com/nitronox

Sincerely,
Mike Civitello
Porter Instrument - Nitronox

"Ushy Fri 21-Dec-12 19:13:41
Don't know if this review undertaken at Imperial college in 2008 by Sanders and Weimann helps:

"Nitrous oxide is the longest serving member of the anesthesiologist's pharmacologic armamentarium but remains a source of controversy because of fears over its adverse effects. Recently, the Evaluation of Nitrous oxide In a Gas Mixture for Anaesthesia (ENIGMA) trial reported that nitrous oxide use increases postoperative complications; further preclinical reports have suggested that nitrous oxide may contribute to neurocognitive dysfunction in the young and elderly. Therefore, nitrous oxide's longevity in anesthetic practice is under threat. In this article, the authors discuss the evidence for the putative toxicity of nitrous oxide, from either patient or occupational exposure, within the context of the mechanism of nitrous oxide's action. Although it would seem prudent to avoid nitrous oxide in certain vulnerable populations, current evidence in support of a more widespread prescription from clinical practice is unconvincing." "

I had G&A in France and pethidine was an option. It's not common and you have to ask but it's there.