Laughing Gas in a Pediatric Emergency Department-Fun for All Participants Vitamin B12 Status Among Medical Staff Working With Nitrous Oxide

The efficiency of nitrous oxide in an equimolar mixture with oxygen or in concentrations up to 70% is approved for short painful procedures. Evaluation of the vitamin B-12 levels in anesthetic staff applying nitrous oxide showed reduced vitamin B-12 plasma levels. This study examines the vitamin B-12 status of medical staff working with nitrous oxide in a pediatric emergency department (ED). Medical staff of the ED at the University Children's Hospital Zurich participated. The vitamin B-12 status was evaluated by measuring homocysteine, methylmalonic acid, vitamin B-12, blood count, and the MTHFR C677T genotype. As a control group, medical personnel working in the "nitrous oxide-free" pediatric intensive care unit were recruited. Results: The parameters for the vitamin B-12 status of all participants were in the reference range, and there were no significant differences for the 2 groups. By trend, the ED staff showed higher vitamin B-12 levels. The ED staff members were slightly older (P = 0.07) and had higher hemoglobin levels (P < 0.04) compared with the pediatric intensive care unit staff. Conclusions: The use of nitrous oxide (50%-70%) with a demand valve is safe for the vitamin B-12 status of medical personnel in the ED.