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Allen J. Hinkle, MD
Hitchcock Clinic Hanover, NH

JAMA. 1984;251(8):1028.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

I read with interest the recent article by Fosburg and Crone¹ entitled "Nitrous Oxide Analgesia for Refractory Pain in the Terminally Ill." Although their technique of providing nitrous oxide (N₂O) analgesia seems safe, I am concerned about this practice for two reasons.

First, most patients who have progressed to the stage of terminal cancer have been exposed to a diverse regimen of chemotherapeutic agents. A few of these agents, most notably doxorubicin hydrochloride (Adriamycin), daunorubicin hydrochloride, cisplatin, and cyclophosphamide (Cytoxan), are cardiotoxic. The anesthetic literature has clearly shown that N₂O alone in concentrations as low as 40% can cause myocardial depression and hypotension.¹ I would venture to guess that with an underlying cardiomyopathy this effect is exacerbated. In their article there is no mention of vital signs during the periods of N₂O administration, which may have helped to convince some . . . [Full Text PDF of this Article]

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