GasGasGas - Anaesthetic Science for Anaesthesia! Nitrous Oxide: Anaesthetic Mechanisms, B12 Toxicity and Safe Storage
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Jan 9, 2026 Dive into the fascinating world of nitrous oxide and its declining role in anesthesia. Discover how this once-popular agent interacts with vitamin B12 and its implications for health. Explore the environmental impact of nitrous oxide and what makes its storage tricky. Learn about its mechanisms in the body, including NMDA antagonism, and the potential risks associated with recreational use. Finally, uncover the importance of understanding its effects on recovery and clinical usage in modern medicine.
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B12 Oxidation Explains Nitrous Toxicity
- Nitrous oxide irreversibly oxidises the cobalt ion in vitamin B12 and impairs methionine synthase.
- This disrupts DNA synthesis and can cause megaloblastic changes and neurologic injury with chronic exposure.
Limit Cylinder Fill To Prevent Overpressure
- Store nitrous oxide cylinders only up to ~75% fill to reduce explosion risk from heating.
- Check filling ratios especially in warmer climates and adjust to local practice.
Nitrous Has Heavy Climate Impact
- Nitrous oxide has a substantial global warming potential (~310× CO2) and contributes to environmental harm.
- Its use is declining partly for climate reasons, though desflurane is worse.