Advertisement

Subacute Combined Degeneration from Recreational Nitrous Oxide Inhalation

  • Michael U. Antonucci
    Correspondence
    Corresponding Address: Michael U. Antonucci, md, Department of Radiology and Radiological Science, Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 323, Charleston, SC 29425
    Affiliations
    Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
    Search for articles by this author
      Nitrous oxide (N2O) has been an anesthetic agent for more than 160 years and remains a pervasive agent today, particularly in dentistry (
      • Sun R.
      • Jia W.Q.
      • Zhang P.
      • et al.
      Nitrous oxide-based techniques versus nitrous oxide-free techniques for general anaesthesia.
      ,
      • Wilson S.
      • Gosnell E.S.
      Survey of American Academy of Pediatric Dentistry on nitrous oxide and sedation: 20 years later.
      ). Interestingly, its potential as a drug of abuse predates both its own clinical use and the advent of modern anesthesia (
      • Robinson D.H.
      • Toledo A.H.
      Historical development of modern anesthesia.
      ). Indeed, in 1799, the English chemist (and future Royal Society president) Humphry Davy began meticulously documenting the effects of inhaling N2O, noting “sublime emotion connected with highly vivid ideas” (
      • Davy H.
      Researches, chemical and philosophical: chiefly concerning nitrous oxide, or diphlogisticated nitrous air, and its respiration.
      ). After consuming progressively increasing amounts through a specially devised “breathing box,” he elected to share the intense derived pleasure with others. The recorded experience of these sessions, which included famed poets and other elite members of late 18th century British society, are now readily available (
      • Davy H.
      Researches, chemical and philosophical: chiefly concerning nitrous oxide, or diphlogisticated nitrous air, and its respiration.
      ,
      • The Public Domain Review
      The nitrous oxide experiments of Humphry Davy.
      ). Davy's contribution also includes experience of near-death overdose.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Sun R.
        • Jia W.Q.
        • Zhang P.
        • et al.
        Nitrous oxide-based techniques versus nitrous oxide-free techniques for general anaesthesia.
        Cochrane Database Syst Rev. 2015; : CD008984
        • Wilson S.
        • Gosnell E.S.
        Survey of American Academy of Pediatric Dentistry on nitrous oxide and sedation: 20 years later.
        Pediatr Dent. 2016; 38: 385-392
        • Robinson D.H.
        • Toledo A.H.
        Historical development of modern anesthesia.
        J Invest Surg. 2012; 25: 141-149
        • Davy H.
        Researches, chemical and philosophical: chiefly concerning nitrous oxide, or diphlogisticated nitrous air, and its respiration.
        J. Johnson, St. Paul's Church-Yard, by Biggs and Cottle, Bristol, London1800
        • The Public Domain Review
        The nitrous oxide experiments of Humphry Davy.
        (Available at:)
        • Thompson A.G.
        • Leite M.I.
        • Lunn M.P.
        • Bennett D.L.
        Whippits, nitrous oxide and the dangers of legal highs.
        Pract Neurol. 2015; 15: 207-209
        • Kaar S.J.
        • Ferris J.
        • Waldron J.
        • Devaney M.
        • Ramsey J.
        • Winstock A.R.
        Up: the rise of nitrous oxide abuse. An international survey of contemporary nitrous oxide use.
        J Psychopharmacol. 2016; 30: 395-401
        • McDermott R.
        • Tsang K.
        • Hamilton N.
        • Belton M.
        Recreational nitrous oxide inhalation as a rare cause of spontaneous pneumomediastinum.
        BMJ Case Rep. 2015; 2015
        • Hwang J.C.
        • Himel H.N.
        • Edlich R.F.
        Frostbite of the face after recreational misuse of nitrous oxide.
        Burns. 1996; 22: 152-153
        • Indraratna P.
        • Alexopoulos C.
        • Celermajer D.
        • Alford K.
        Acute ST-elevation myocardial infarction, a unique complication of recreational nitrous oxide use.
        Heart Lung Circ. 2017; 26: e41-e43
        • Wagner S.A.
        • Clark M.A.
        • Wesche D.L.
        • Doedens D.J.
        • Lloyd A.W.
        Asphyxial deaths from the recreational use of nitrous oxide.
        J Forensic Sci. 1992; 37: 1008-1015
        • Sanders R.D.
        • Weimann J.
        • Maze M.
        Biologic effects of nitrous oxide: a mechanistic and toxicologic review.
        Anesthesiology. 2008; 109: 707-722
        • Ravina B.
        • Loevner L.A.
        • Bank W.
        MR findings in subacute combined degeneration of the spinal cord: a case of reversible cervical myelopathy.
        AJR Am J Roentgenol. 2000; 174: 863-865
        • Kumar A.
        • Singh A.K.
        Teaching neuroimage: inverted V sign in subacute combined degeneration of spinal cord.
        Neurology. 2009; 72: e4
        • Yuan J.L.
        • Wang S.K.
        • Jiang T.
        • Hu W.L.
        Nitrous oxide induced subacute combined degeneration with longitudinally extensive myelopathy with inverted V-sign on spinal MRI: a case report and literature review.
        BMC Neurol. 2017; 17: 222
        • Oh R.
        • Brown D.L.
        Vitamin B12 deficiency.
        Am Fam Physician. 2003; 67: 979-986
        • Roach E.S.
        • McLean W.T.
        Neurologic disorders of vitamin b12 deficiency.
        Am Fam Physician. 1982; 25: 111-115
        • Langan R.C.
        • Goodbred A.J.
        Vitamin B12 deficiency: recognition and management.
        Am Fam Physician. 2017; 96: 384-389
        • Schilling R.F.
        Is nitrous oxide a dangerous anesthetic for vitamin B12-deficient subjects?.
        JAMA. 1986; 255: 1605-1606
        • Layzer R.B.
        Myeloneuropathy after prolonged exposure to nitrous oxide.
        Lancet. 1978; 2: 1227-1230