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The dentist who sat on her chair and lost a leg. N2O?
1Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
2 Vita-Salute San Raffaele University, Milan, Italy
*Corresponding Author(s): GIOVANNI LANDONI E-mail: landoni.giovanni@hsr.it
A 35-year-old female dentist laid on her chair to test an N2O machine, and after only a few minutes of inhaling the N2O, she developed acute pyramidal syndrome. The patient started walking again eight months later, but still suffers from lower limb motor deficit, in spite of intensive re-habilitation. Genetic tests later showed that the patient had Type 3 homocystinuria. This is the first case report of acute neu-rological toxicity after brief administration of N2O. We suggest starting vitamin B12 and folic acid supplements promptly in pa-tients who experience neurological symp-toms after receiving N2O.
case report, neurological toxic-ity, nitrous oxide, adverse reaction, homo-cystinuria, dental care
GIOVANNI LANDONI,PASQUALE NARDELLI. The dentist who sat on her chair and lost a leg. N2O?. Signa Vitae. 2017. 13(2);116-117.
1. Benavides R, Maze M, Franks NP. Expansion of gas bubbles by nitrous oxide and xenon. Anesthesiology 2006;104:299-302.
2. Massey TH, Pickersgill TT, J Peall K. Nitrous oxide misuse and vitamin B12 deficiency. BMJ Case Rep 2016 May 31;2016. pii: bcr2016215728. doi: 10.1136/bcr-2016-215728.
3. Hadzic A, Glab K, Sanborn KV, Thys DM. Severe neurologic deficit after nitrous oxide anesthesia. Anesthesiology 1995;83:863-6.
4. Deloughery TG1, Evans A, Sadeghi A, McWilliams J, Henner WD, Taylor LM Jr, Press RD. Common mutation in methylenetet-rahydrofolate reductase: correlation with homocysteine metabolism and late-onset vascular disease. Circulation 1996;94:3074-3078
5. Emmanouil DE, Quock RM. Advances in understanding the actions of nitrous oxide. Anesth Prog 2007;54:9-18.
6. Myles PS, Leslie K, Chan MT, Forbes A, Peyton PJ, Paech MJ, Beattie WS, Sessler DI, Devereaux PJ, Silbert B, Schricker T, Wallace S; ANZCA Trials Group for the ENIGMA-II investigators. The safety of addition of nitrous oxide to general anaesthesia in at-risk patients having major non-cardiac surgery (ENIGMA-II): a randomised, single-blind trial. Lancet 2014;384:1446-54.
7. Brodsky JB, Cohen EN, Brown BW Jr, Wu ML, Whitcher CE. Exposure to nitrous oxide and neurologic disease among dental profes-sionals. Anesth Analg 1981;60:297-301.
8. Intercollegiate Advisory Committee on Sedation in Dentistry. Standards for Conscious Sedation in the Provision of Dental Care, 2015. Available at: https://www.rcseng.ac.uk/fds/Documents/dental-sedation-report-2015-web-v2.pdf. Accessed on June 17th, 2016.
9. Nagele P, Brown F, Francis A, Scott MG, Gage BF, Miller JP; VINO Study Team. Influence of nitrous oxide anesthesia, B-vitamins, and MTHFR gene polymorphisms on perioperative cardiac events: the vitamins in nitrous oxide (VINO) randomized trial. Anesthesiol-ogy 2013;119:19-28.
10. Selzer RR, Rosenblatt DS, Laxova R, Hogan K. Adverse effect of nitrous oxide in a child with 5,10-methylenetetrahydrofolate reduc-tase deficiency. N Engl J Med 2003;349:45-50.
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