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///2017 Abstract Details
2017 Abstract Details2019-08-02T15:54:53-05:00

Analgesic Nitrous Oxide Use for Labor and Delivery

Abstract Number: F-55
Abstract Type: Original Research

Natesan Manimekalai MD1 ; Peter Fliss DO2; Forrest Duncan MD3; Gerri Wilson PhD4; Lir-wan Fan PhD5; Michelle Tucci PhD6

Introduction: Epidural administration of local anesthetic agents and systemic opioids are frequently used for labor and delivery in the United States, while in many other countries a blend of nitrous oxide and oxygen (50:50) has been used since the early 1990’s There have been no observations that report significant adverse effects in neonate resuscitation, alertness, maternal-infant bonding, and because of these reports, the interest to reestablish the use of the N2O/O2 mixture in the United States is on the rise. A review of the literature shows many anesthetic agents, including N2O/O2 mixtures, when administered during critical phases of early brain development, causes neurodegenerative changes and learning abnormalities in rat pups, but the use of analgesic doses have not been investigated. Our study is the first to compare changes in the brain of P0 rat pups subjected to 50% nitrous oxide for 1 hour prior to delivery. Method and Study Design: The experiment consisted of pregnant rats in two experimental groups at day 23 exposed to every 5 minutes for 60 minutes to a 50% mixture of N2O/O2 prior to delivery, while the control rats were exposed to room air. Upon delivery, pup brains were collected and processed for histology. Brains were stained with Nissl stain and with antibodies against microglial and astrocytes. Results: Preliminary analysis of the two groups showed both male and female rat pups exposed to 50% nitrous oxide for one minute every five minutes for 60 minutes prior to delivery had significant changes in the white matter compared with pups exposed to room air. The histology shows early injury reaction with glial cell and astrocytes (arrows). Data is consistent with acute brain changes that are associated with hypoxia. Normal preterm brain shows transient clusters of microglia in the white matter which are important for elimination of transcallosal projections during brain development. This area appears to be vulnerable to injury in the preterm brain. Microglial activation (orange cells in the figure) can lead to the production of proinflammatory mediators that damage the white matter. Conclusion: The preliminary results showed early damage in the white matter which is consistent with hypoxia changes. Additional experiments are being performed to obtain statistical differences between the groups. Our results suggest studies are needed to determine if the damage is transient or leads to long term motor and learning deficits.

SOAP 2017