The University of Toledo Translation Journal of Medical Sciences 
Internal Medicine Abstract, Department of Medicine Research Symposium UTJMS 2023 May 5; 11(1):e1-e1 

Applications of Inhalational Nitrous Oxide in Patients as 
an Alternative to Traditional Narcotics and Sedation 
Agents in the Emergency Department 

Vanessa Pasadyn, BA1*, Mohamad Moussa, MD2, Sadik Khuder, PhD1 

1Division of Internal Medicine, Department of Medicine, The University of Toledo, 
Toledo, OH 43614 
2Department of Emergency Medcine, The University of Toledo, Toledo, OH 43614 

*Corresponding author: vanessa.pasadyn@rockets.utoledo.edu

Published: 05 May 2023 

This is the case of a 76-year-old woman who received nitrous oxide as analgesia for a shoulder reduction 
in the emergency department (ED). The goal of discussing this case is to emphasize the accessibility, 
efficacy, and safety of using nitrous oxide as a sedation agent in place of narcotics in the ED. From 
4/11/22-6/15/22, nitrous oxide has been used as an analgesic at two of ProMedica Toledo’s Hospital 
emergency departments 50 times for a variety of encounters ranging from laceration to open limb 
fracture repair. This effort is in support of the ProMedica Toledo’s PAIN (Prescribing Alternatives 
Instead of Narcotics) program with an overarching goal to reduce opioid use in the ED. Nitrous oxide 
can be used for analgesia, pain management, and anxiolysis. It is a colorless, odorless gas that has rapid 
onset of 1-2 minutes and a short duration of 3-5 minutes. Nitrous has minimal effects on respiration and 
hemodynamics and has a minimal side effect profile compared to other sedatives. Nitrous is easy to 
administer, thus there are a wide variety of indications such as being used as an adjunct in fracture 
reduction, cardioversion, or foreign body removal. The opioid epidemic is an ever present and growing 
issue in the United States and any effort to curb narcotic use is imperative to prioritize. It is the 
responsibility of caregivers to learn and understand the indications and contraindications of the use of 
nitrous oxide as an analgesic. This is a meaningful step in working to curb the opioid epidemic and 
optimizing patient care in the acute setting. 

https://dx.doi.org/10.46570/utjms.vol11-2023-709 

https://dx.doi.org/10.46570/utjms.vol11-2023-709
mailto:vanessa.pasadyn@rockets.utoledo.edu