I was part of a medical team which studied Nitrous Oxide (N2O) use on ambulances for more than a decade. N2O is not an analgesic; it is a hypnotic. Its effects can be directly attributed to the users expectations and the suggestions of others.
The term “laughing gas” is an unfortunate misnomer, derived from serious complications which occurred in the early years of its use with masks held in place with straps. In a nutshell: N2O has an affinity to cross the barrier (alveoli) between the gas containing lung and blood containing pulmonary artery. It does this very easily and rapidly - in both directions. After inhaling a certain concentration of N2O it will begin to diffuse out of the bloodsteam, back into the lungs for exhalation. This happens with enough force to inhibit the movement of oxygen across the alveoli into the bloodsteam. The user cannot get oxygen into the bloodsteam, the brain becomes hypoxic, and one of the ensuing signs is laughter. The Nitrous Oxide does not cause you to laugh, suffocating from lack of oxygen to your brain does.
This condition is referred to as “diffusion hypoxia”. There are two ways to prevent this, and both are standard practice with modern medical use of N2O. 1) N2O is used with an equal concentration of oxygen. It is designated N2O:O2. 2) The patient must hold the administration device themselves; it is never strapped on as an oxygen mask might be. In this way, the device will fall away if the patient becomes at all dizzy or loses coordination. This will occur well before hypoxia becomes a problem.
Because N2O is a hypnotic, it is not unusual for a patient to laugh, if that is what they expect of the “laughing gas”. A better medical use is to suggest the relief of pain. For this reason, no medical provider should ever refer to N2O as “laughing gas” when administering it to a patient.
It can be very effective in the treatment of labor pain. Midwives in England pioneered a resurgence of its out-of-hospital use in modern times.
I think I believe you. I have been administered “laughing gas” once, when a dental office was unable to deaden the nerves in my wisdom teeth before cutting them apart and removing them. (They actually ran out of novacaine! Who ever heard of that?) It didn’t seem to work with a crap.
But, … I can remember college students regaling each other with stories of doing whippets and so-and-so’s head bouncing off the floor - without pain. (This one guy apparently would fall off his chair, bouncing his head on the tile, get back up and do it again.) I can believe during the actual head dribble, that losing consciousness would deaden the pain. But not when climbing back up in the chair. What gives with that?
I think I believe you. I have been administered “laughing gas” once, when a dental office was unable to deaden the nerves in my wisdom teeth before cutting them apart and removing them. (They actually ran out of novacaine! Who ever heard of that?) It didn’t seem to work with a crap.
But, … I can remember college students regaling each other with stories of doing whippets and so-and-so’s head bouncing off the floor - without pain. (This one guy apparently would fall off his chair, bouncing his head on the tile, get back up and do it again.) I can believe during the actual head dribble, that losing consciousness would deaden the pain. But not when climbing back up in the chair. What gives with that?
I gotta tell ya, my experience with nitrous oxide is that it definitely induces a severe case of laughter, at least in me. The first time I tried sucking it straight out of a balloon, the sensations it induced made me laugh uncontrollably. I wasn’t expecting this, and the other people with me weren’t affected that way, but that’s what it did to me (and, I’ve heard, to many other people, although obviously not everyone reacts like this). I’d had N2O/O2 mix at the dentist’s office as a kid and while it made me light-headed and the like, it never made me laugh. It’s only at very high concentrations that it seems to have that effect on me.
I’m an anesthesiologist and use N20 pretty much daily. On the current machines we have a selection of 3 or 4 “gases” we can deliver via the respirator to our vicitms (I mean “patients”). One of them is nitrous oxide, the others are halogenated ether derivatives (Halothane, Enflurane, Desflurane, Isoflurane, Sevoflurane).
All of these gases are delivered in terms of “MAC”–Minimum Alveloar Concentration. That is, the minimum concentration of gas that must be present in the alveoli of the lungs to prevent half of patients from moving in response to surgical stimuli.
I have to disagree with DogCamel in calling N20 a “hypnotic” only. At low concentrations (<50%) this is more true than not. However, not only is nitrous oxide a fully fleged “anesthetic” agent (in that it provides loss of awareness & anterograde amnesia, analgesia, & muscle relaxation), it is very nearly the ideal agent in terms of safety, inertness, and expense. It’s cheap, it undergoes almost no metabolism in the body, and it’s not flammable (a problem with early inhaled anesthetics). It has a low low blood:gas solubility which means it comes off rapidly–in a matter of minutes–regardless of the length of surgery. It has very little effect on the cardiovascular system (the halogenated agents typically do).
The problem with nitrous oxide is that the “MAC” is 105% inspired concentration. That is, you’d have to be in 105% pure nitrous oxide to be anesthetized. This is obviously not achievable under normal circumstances. The best you can do is around 70%, which leaves another 30% for oxygen. On the other hand, if you’re willing to step into a hyperbaric chamber and ramp up to around 1.5 ATM, full surgical anesthesia can and has been be achieved with nitrous oxide alone.
There are also some problems with expansion of gas spaces (bowels), and as DogCamel correctly describes, you need to watch for diffusion hypoxia. Some also claim it causes more nausea and vomiting post-op, but YMMV. Still, what we do most often in clinical practice is mix about 60% nitrous in to the breathing mix to reduce the overall need for the halogenated agents.
Anyway, euphoria is more common than not at higher concentrations. And for the record, I don’t think a full 50% of medical students have tried nitrous oxide…at least not in a professional setting…
I was able to partake in this great use of medical technology when I had my wisdoms pulled. It definitely made me laugh – I was cackling like a total dork and I could not stop even though I tried. Also, the last thing I remember involved my eyesight freezing like a snapshot from a camera yet I was aware of movement/sound around me. That was extremely weird, even a little scary. I kept flexing my arm/leg and I could feel it moving but I couldn’t see it move…
Just a quick comment on the “In store whippit” referred to in the authors quote.
Inverting the can wil simply get you a mouthfull of whipped cream.
In fact, the optimum method is to hold the can upright and shake it as little as possible.
In 1995, a friend of mine went to a highschool party where balloons of nitrous oxide (“nitrous”) were being sold for recreational use. It was an infrequent thing he did now and again in such settings. As noted in the column, there aren’t many side effects or dangers of becoming dependent. He considered it a safe drug, especially compared to other things available in that type of environment.
After a few balloons, something wasn’t going quite right. He became confused and paranoid. He told me later that it was if he entered into a delusional video game reality. In the course of trying to escape from a “level,” he encountered his ex-girlfriend, who he thought was “an enemy I had to beat”. He assaulted her and she ended up with broken bones and missing teeth. He ended up with a jail term, fines, and an extended house-arrest with one of those transmitters around his ankle for a few months. His family was sued for medical damages.
Nitrous oxide is a pretty mellow drug, and this guy was one of the nicest in our crowd, so everybody was very confused and stunned.
We eventually realized the he had inhaled the balloons faster than normal, one right after the other without pausing to take a sufficient breather. He was exhibiting symptoms of oxygen deprivation delusions (albeit an extreme example).
The symptoms of oxygen deprivation are something that should be considered alongside any more traditionally recognized side-effects of a drug that’s inhaled, sniffed or huffed.
I have always considered the effects of Nitrous Oxide to be similar to Nitrogen Narcosis, experienced by deep divers. In that case, oxygen deprivation could not be considered a factor. It seems to me that these two types of intoxicating effects may have, at the root, the same mechanism - somehow an inert substance gets infused into, and interferes with, the neuronic activity of the brain (clearly IANAD). As soon as the source of the inert substance is removed, it diffuses away rapidly and all returns to normal. Any known connection between these two phenomena?
I find this extremely hard to believe. I don’t really know anything about you, so I have no reason to believe that you would lie, I just see a few problems with this. I’ve experimented quite a bit with nitrous. The most i’ve done is 4 canisters in a row, with maybe one breath of oxygen inbetween - the goal was to see if I could get myself to pass out. Of course, I got a great high, but I simply could not force my body to deprive itself of that much oxygen. After 3 balloons it’s pretty difficult to do much more than hold a balloon to your mouth, and I really don’t see how someone could manage to move enough to beat someone up.
My brother, myself, and a friend of mine can all testify to one thing: inhaling a full large balloon of helium, over a period of about 30-40 seconds, caused us each to pass out. I don’t know how nitrous oxide differs from helium in this regard, though – I figured the results from helium were purely an oxygen-deprivation thing. In any case, we definitely didn’t have the ability to be moving around and beating somebody up … but again, I don’t know if nitrous oxide has a different effect.
On another note, I’ve read that nitrous oxide is a dissociative in the same class as PCP, ketamine, and dextromethorphan.
Once (many moons ago when I was a silly pup) after “topping off” with a little N20 I watched the Hyatt Regency melt. Didn’t last long, tho. And I’ve never seen anyone come to harm as an immediate result of N2O.
I did, however, see a couple of Deadheads get arrested for selling balloons of the stuff from a stolen can out of their hatchback in an Orlando parking lot. On the whole, it beats the heck out of “rush” or whatever they call that trash these day. The only guy I ever knew who was really into that stuff is now dead.
Oh, and one crazy sumb***h I knew elsewhere in Florida once did a spread eagle face-plant in the dairy bin of a Publix supermarket after challenging another equally crazy friend to a whippet duel. Lucky for him, the security guard was a retiree who wasn’t even able to catch him as he careened, laughing hysterically, out of the store.
I don’t know how you’re using the word “class” here, but (from what I’ve heard) N2O isn’t even in the same universe as PCP or ketamine, although ketamine has a history as a veterinary anesthetic. If I found out one of my kids did a little N2O, we’d have a little talk. If they did PCP or ketamine, some serious measures would be taken.
I have been to enough concerts and festivals (and house parties) to know that the laughter comes not from the gas or lack of oxygen, but from uncontrollable laughter at the ridiculous voices you can make with it (deep, almost evil but funny voices). (thats just a little joke). Also it’s great to laugh at people that turn blue until you realize that is because they are basically suffocating from doing to much too quickly. I have passed by whole groups (from 5 - 40+) people passed out on the grass at concert passing out or falling down laughing. Its nothing to play with.
Having recently completed years of overdue dental work, I’m very lovingly familiar with the anesthetic and relaxation properties of N20. I’m still terrified of the drill, but I simply don’t care so much once the nitrous flows.
The techs at my office report a lot of side effects like John W. Kennedy’s experience, patients babbling and often losing that fine distinction of what’s appropriate conversationally. I heard a lot of “I’d take a valium but not use nitrous because I’m afraid of what I might say” from them. Just another anecdote for the pile.