Frequently asked questions on ENTONOX®
What is ENTONOX used for?
ENTONOX is ready-to-use gas mixture consisting of 50% nitrous oxide and 50% oxygen; it is used exclusively for short term pain relief in a wide range of settings. It has the advantage of very rapid onset and offset analgesic action.
ENTONOX is widely used in obstetrics during childbirth, for emergency care in the ambulance service and for minor painful procedures in hospitals and clinics including:
- acute trauma
- suturing
- wound dressings
- colonoscopies
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NextCan ENTONOX be used with children?
Yes, ENTONOX (50% nitrous oxide/ 50% oxygen medical gas mixture) is a fast-acting, non-invasive analgesic that is particularly advantageous for treating short term procedural pain in children.
ENTONOX is licensed for use across all age groups. As long as the child is able to activate the demand valve and understand instructions on how to use the equipment, then it is safe to use.
Does ENTONOX cross the placenta to the newborn?
Yes ENTONOX is known to cross the placenta but is reassuringly safe to both mother and newborn during labour. It has no known negative effects on the baby. In fact the Oxygen component will increase the levels of Oxygen in the bloodstream, which is good for the baby.
What’s new with ENTONOX?
BOC Healthcare is introducing a wide range of new equipment to use with our ENTONOX medical gas. As well as having convenient and cost effective integrated valve technology on our cylinders we have recently introduced a range of new products, including:
- A high quality ENTONOX Demand Valve,
- A versatile and convenient ‘all-in-one’ pain relief package consisting of a twin cylinder bag and optional trolley wheels
Additionally a new pain management education package from BOC Healthcare is on the horizon, due to be online early in 2009, This will give you the chance to learn all about how pain is perceived, the variety of analgesics available (including ENTONOX), and how each of these analgesics work and the associated advantages and disadvantages.
How do I transport ENTONOX cylinders?
ENTONOX medical gas is classed as a Pharmacy Only drug and can only be supplied to an authorised healthcare professional.
A Tremcard is required by Healthcare professionals for transporting ENTONOX. This can be provided by BOC Healthcare for its customers upon request (0800 111 333). It is also a requirement for the green diamond compressed gases safety sign to be displayed on the vehicle when cylinders are being transported. Windscreen signs are available from BOC Healthcare for community midwives.
We would also recommend that gas cylinders are secured and transported in the boot of a vehicle, ideally with a Cargo net or fixed with a Karibiner and strap. There should be adequate ventilation within the car and it is advisable to inform your Insurance company if you have not done so already.
Can I use ENTONOX with a tracheostomy?
It is possible to use ENTONOX with a tracheostomy but a special connector would be required to allow this to happen. With a tracheotomy, you would need to use a small neonatal mask attached to the demand valve.
Does BOC provide training on ENTONOX?
Yes, BOC can provide a range of training options. We are currently developing a new online education programme for 2009 which will replace all previous video and paper based training material. On site training for small groups can be arranged for existing BOC customers via account managers and therapy specialists upon request (there may be a charge for this type of training to cover costs).
How long do you have to wait to drive after using ENTONOX?
The drive time is now 30minutes following administration of ENTONOX.
What areas, other than maternity, is ENONTOX being used in?
There’s a lot of interest and use of ENTONOX for colonoscopies, pre hospital emergency care and many other short painful procedures such as painful wound dressings, intramuscular injections etc. When used for such procedures it allows for a faster turn around time for your patients and is often a more economic alternative to intravenous drugs.
Is it safe to use ENTONOX whilst pregnant?
Yes, it is safe to use ENTONOX during pregnancy. However, as with all medicinal products, it is wise to avoid during the first and second trimester but guidance will be given by your healthcare professional.
Is it safe to be exposed to ENTONOX during pregnancy?
Yes, there are no studies in humans that show that being exposed to this product has any affects on the growing foetus. One study in rats (1), exposed to very high levels of nitrous oxide continuously for prolonged periods (24 hours) did show some affect on the foetus. But the use of continuous flow for extreme lengths of time meant the level of exposure in this study was 50 times higher than the current occupational exposure level of 100ppm. Therefore providing ENTONOX is used correctly for short term procedures and self-administered using a demand valve it is very safe.
How long does it take for ENTONOX to work?
Its effects are apparent within four to five breaths reaching maximal effect within about two to three minutes of inhaling the gas. Furthermore, due to its low fat solubility, ENTONOX does not accumulate within the body to any great extent; it is rapidly eliminated via the lungs when inhalation ceases.
Does the patient need to be fasting?
No. This is not a requirement for ENTONOX administration but care should be taken and local protocols followed.
Does ENTONOX pollute the environment?
Like carbon dioxide and methane, nitrous oxide is a gas which contributes to the global warming effect. Nitrous oxide is mostly produced from agriculture, fertilisers, animal waste and industrial production. Medical use represents a small contribution, less than 1% of total global nitrous oxide emissions (2, 3) compared to livestock which contributes 65% and manufacturing industries which contributes 20%.
References:
(1) Fang F et al. Opiate receptors in the periaqueductal gray mediate analgesic effect of nitrous oxide in rats. EurJ Pharmacol 1997; 336:137–41.
(2) Dunning DG, McFarland K, Safarik M. Nitrous-oxide use. II. Risks, compliance, and exposure levels among Nebraska dentists and dental assistants. Gen Dent. 1997 Jan-Feb;45(1):82-6.
(3) Hoerauf K, Funk W, Harth M, et. Al. Occupational exposure to nitrous oxide and desflurane during earnose-throat-surgery. Can J Anesth. 2000 47:10:pp 984–988.
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