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(Chest. 2005;128:863-868.)
© 2005 American College of Chest Physicians

Prefixed Equimolar Nitrous Oxide and Oxygen Mixture Reduces Discomfort During Flexible Bronchoscopy in Adult Patients*

A Randomized, Controlled, Double-Blind Trial

Kinan Atassi, MD; Gilles Mangiapan, MD; Claire Fuhrman, MD; Stéphane Lasry, MD; Peter Onody, PharmD and Bruno Housset, MD

* From the Service de Pneumologie et de Pathologie Professionnelle (Drs. Atassi, Mangiapan, Fuhrman, Lasry, and Housset), CHI de Créteil, Créteil; and Air Liquide Santé International (Dr. Onody), Paris, France.

Correspondence to: Kinan Atassi, MD, Centre Hospitalier Intercommunal, Service de Pneumologie, 40 avenue de Verdun, 940000 Créteil, France; e-mail: kinan.atassi{at}chicreteil.fr

Study objectives: Flexible bronchoscopy (FB) is an invasive procedure associated with patient discomfort and frequent nose pain. A simple sedation procedure that does not require the intervention of an anesthetist is of interest. The aim of this prospective, randomized, double-blind study was to assess efficiency of nitrous oxide inhalation on the reduction of FB-induced discomfort in adult patients.

Design and settings: Two hundred six patients were randomized to receive either a prefixed equimolar nitrous oxide/oxygen mixture (N2O) or a prefixed equimolar nitrogen and oxygen mixture (control). The primary outcome was stress as assessed by pulse rate and systemic BP during the procedure. Secondary outcomes were self-assessed pain using a visual analog scale (VAS) and patient satisfaction based on a questionnaire. Adverse events were recorded.

Results: A significant increase in BP was observed only in the control group (p = 0.003), while pulse rate values did not differ between the two groups. As assessed by the VAS, pain was lower in the N2O group as compared to placebo (p = 0.02). Nose pain and cough were also significantly reduced by N2O. Adverse events, mostly anxiety, were reported in 10 patients.

Conclusion: These results indicate that equimolar N2O inhalation is efficient in reducing patient discomfort and may be an alternative to general anesthesia.

Key Words: bronchoscopy • conscious sedation • outpatients • randomized trial






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