Good Practice in Postoperative and Procedural Pain Management ...

pressure and volume from the diffusion of nitrousoxide into closed air-containing cavities and is thereforecontraindicated in the presence of pneumothorax.Frequent side effects include euphoria,disinhibition, dizziness, dry mouth, and disorientation.Nausea and vomiting can occur. Excessive sedationis managed by discontinuation of the gas,oxygen administration, and basic airway management.Prolonged or frequent use may affect folate metabolismleading to megaloblastic changes in the bonemarrow, megaloblastic anemia, and peripheral neuropathy.Depression of white cell formation may alsooccur. Patients who receive N 2 O more frequentlythan twice every 4 days should have regular bloodcell examination for megaloblastic changes and neutrophilhypersegmentation.Exposure to prolonged high concentrations of N 2 Ohas been associated with reduced fertility in men andwomen. It should only be used in a well-ventilatedenvironment, which should be monitored and maintainedbelow the UK Occupational Exposure Standardfor atmospheric levels of N 2 O that is 37 2.0 ml maximumEach ‘dip’ of the pacifier is estimated to be 0.2 ml.The effectiveness of sucrose appears to decrease withage, at present it’s use as a primary analgesic shouldbe confined to the neonatal period until further informationis available.6.8.2 Sucrose side effects and toxicityCoughing, choking, gagging, and transient oxygen desaturationshave been reported; when using the syringemethod, the solution should be applied carefully to thetongue one drop at a time. There is some evidence thatadverse effects of sucrose, including a temporaryincrease in ‘Neurobiologic Risk’ score, is more frequentin very premature infants, particularly those