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Bone marrow rescue following nitrous oxide

Published online by Cambridge University Press:  05 November 2014

Henry Paw  and
Rob Shulman
Henry Paw
Affiliation:
York Hospital
Rob Shulman
Affiliation:
University College London
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Summary

  1. • Folic/folinic acid 15 mg IV for 2 days

  2. • Vitamin B12 1 mg IV for 2 days

The use of nitrous oxide for anaesthesia in excess of 2 h inactivates vitamin B 12 and may lead to impaired DNA synthesis and megaloblastic bone marrow haemopoiesis. In fit patients this is of little significance, but in the critically ill it may increase the mortality rate. Haemopoeitic changes induced by nitrous oxide can be reversed by folic/folinic acid. Vitamin B12 is given to replace that which has been inactivated. It is recommended by some authorities that both folic/folinic acid and vitamin B12 should be given to critically ill patients following surgery in which nitrous oxide was used as part of the anaesthetic for >2 hours.

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Handbook of Drugs in Intensive Care
An A-Z Guide
 , pp. 287
Publisher: Cambridge University Press
Print publication year: 2014

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