Nitrous oxide is an N-methyl-D-aspartate receptor antagonist and may reduce the incidence of chronic post-surgical pain.Nitrous oxide oxidizes Vitamin B12 and can precipitate sub-acute combined degeneration of the cord with chronic use or in patients with folate/B12 deficiency.Nitrous oxide expands air spaces and is contraindi-cated in patients with pneumothorax or recent (up to 4-6 weeks) ocular surgery using intraocular gas.Nitrous oxide has global warming and ozone depletion potential and its concentration in the theatre environment is regulated.The ENIGMA-II trial showed that nitrous oxide does not increase the risk of death or cardiovascular complications.
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