The effect of the anesthetic nitrous oxide used in pediatric dentistry on the reduction of vitamin B12 and liver function

Ehssan N. Jasim Al-Obaidy. The effect of the anesthetic nitrous oxide used in pediatric dentistry on the reduction of vitamin B12 and liver function. Cardiometry; Issue No. 33; November 2024; p. 71-74; DOI: 10.18137/cardiometry.2024.33.71-74; Available from:

In recent times, there has been significant focus on nitrous oxide (N2O), commonly referred to as laughing gas, because to its usage in nightlife (with addictive properties) and, regrettably, in educational settings. Recreational use of nitrous oxide has shown a surge since 2017. Nitrous oxide is not entirely safe for usage, and unlike other psychoactive drugs, there are no legal restrictions in place to prevent access to it, even for non-adults. Promoting widespread consciousness to deter the recreational utilization of nitrous oxide and avert its anticipated catastrophic consequences. [1]. Dispensing gasoline in a lawful manner that is not subject to drug regulations. The molecular data suggests the molecular formula: Nitrous oxide. The molecular weight is 44.013 grams per mole. Nitrous oxide, sometimes referred to as dinitrogen oxide or dinitrogen monoxide, is a chemical substance with the formula N2O. It is also known as laughing gas, nitrous, nitro, or NOS. At normal ambient temperature, it exists as a transparent gas that is not easily ignited, and possesses a faintly pleasant scent and flavor. Characteristics of nitrous oxide (N2O). N2O is the chemical formula for nitrous oxide. The molecular weight or molar mass is 44.013 grams per mole. The density of the substance is 1.98 kg/m3. Its boiling point is 88.48°C, and its melting point is 90.86°C.

N2O is mostly utilized in laboratory settings, medical facilities, and dental practices as a surgical anesthetic. Additionally, it is employed in the food business to serve as a propellant in canned whipped cream. Nevertheless, N2O can serve as an anesthetic. A study revealed that over 3% of students from Walloon and Brussels regions were already in possession of a diploma before enrolling in upper secondary education, namely in the second and third levels. They ingest N2O at least once during their lifetime. Based on the VAD Nightlife Survey, 3.4% of participants reported using nitrous oxide at least once over the pre- vious 12 months in 2018. This tendency is consistent and steady when compared to the preceding wave of the survey[3]. Within a few seconds of breathing in the gas, an individual experiences a state of intoxication, sometimes referred to as a “high,” which subsides rapidly within a few minutes. It elicits feelings of happiness, cheerfulness, and enthusiasm in individuals. Laughter is prevalent and, as a result, widespread. Another way that is gaining popularity is to directly inhale from gas cartridges or a gas bottle. N2O becomes undetectable after usage as it is eliminated by the kidneys within 1 hour. [4]

N2O is particularly favored by individuals in the age range of 12 to 25, particularly among young people. Individuals who are young and lack expertise, those with cardiovascular diseases, and those with a deficiency in vitamin B12 are more susceptible and prone to experiencing detrimental consequences both in the short and long term. Moreover, relying on dietary supplements to elevate your vitamin B12 levels may not be effective due to potential limitations in absorption [5].

Immediate negative consequences Commonly, N2O is utilized without any apparent manifestation of issues, so it is frequently perceived as being secure. Recreational use of nitrous oxide typically leads to irritation of the nose, throat, eyes, skin, and respiratory system. It induces cerebral hypoxia and functions as a neuroanesthetic, potentially resulting in impaired cognitive response, cephalalgia, vertigo, visual impairment, cognitive disarray, emesis, diarrheal episodes, equilibrium disturbances, motor coordination impairments, and retinal defects [6]. Transient memory, hallucinations, paresthesia, and syncope. Intoxication can induce impulsive and dangerous conduct, rendering the individual a threat to both themselves and others. The user may experience heart and respiratory complications, which might lead to loss of consciousness, coma, and potentially fatal outcomes. Furthermore, the gas has a high degree of volatility, so posing a significant hazard of fire and explosion, which can lead to severe damage to the hands and face. The hazards associated with nitrous oxide usage are elucidated in a manner that highlights its heightened peril in certain scenarios, such as traffic or among those who smoke. For severe injuries affecting the hands and face. The dangers associated with nitrous oxide usage are elucidated in the description, highlighting its heightened danger in certain situations such as traffic or among smokers. The effects can be intensified when com- bined with the use of sleeping medications, tranquilizers, or alcohol. There have been recorded instances in which the user exhibits significant agitation, aggression, destructiveness, and may demonstrate suicidal inclinations. Directly breathing nitrous oxide (N2O) from a chilly gas cylinder can cause freezing of the lips, mouth, throat, and lungs. In addition, N2O cartridges can release toxic metal particles that can be inhaled into the lungs [7].

In addition, those who have a cold may experience lasting hearing impairment as a result of the intense pressure exerted on their eardrums. While the utilization of other drugs remains restricted, a growing number of individuals who have come into contact with nitrous oxide have reached out to the Center for Control. The user’s text is “[8]”. Vitamin B12 absorption is essential. Previously, it was seen as a condition resulting from a deficit of nutrients, mostly caused by The elderly, particularly those of northern European descent, have a restricted ability to absorb the vitamin. Vitamin B12 insufficiency is increasingly recognized as a worldwide issue, typically resulting from insufficient dietary intake, particularly among children and women of reproductive age [9].

Vitamin B12 insufficiency mostly affects the circulatory and neurological systems. The initial identification of vitamin B12 deficiency was mostly observed in cases of pernicious anemia, however the underlying cause was still unknown at that time. Since that time, there has been a significant and noticeable shift in the spectrum, which began with the reappearance of the sickness [10].

The aim of the Study : Determination of B12 vitamin and GOT/GPT in the blood using REITMAN-FRANKEL Colorimetric method ENDPOINT in plasma of blood Childs with NITROUS OXIDE AND ANAESTHESIA.

MATERIALS AND METHODS

Equipment ,Classes and martials used in the Experiment:

• 1    - Photometer for measurements at 505 nm ± 15 nm.

• 2    - Thermostatic water bath set at 37 o C (± 1 o C).

• 3    - Stopwatch.

• 4    - Pipettes of 5.0 mL, 1.0 mL and 0.1 mL.

• 5    - Glass tubes.

• 6    – REAGENT COMPOSITION: We used kit for Vitamin B12(ELISA Kit) From LONDON HEALTH company.[10]

• 7    – REAGENT COMPOSITION: We used kit for GOT/GPT( Human Aspartate aminotransferase, GOT/ GPT ELISA Kit) From MyBioSource company.[11]

STUDY SAMPLE

We took two groups of 20 children. For ages 5 to 12 years, the first group 10 Childs is for children who are brought to dental clinics and are given nitrous oxide gas as an anesthetic for dental surgery, and the second group is a healthy control group 10 Childs without anesthesia. A sample of venous blood 3 ml (whole blood) was taken and separated with a centrifuge for the purpose of separating the serum from the raw blood and keeping it in the freezer at a temperature of -8°C for the purpose of evaluating liver function and vitamin B concentration. [12]

REAGENT COMPOSITION

Method for Determination of Cyanocobalamin (Vitamin B12) In plasma blood : We used kit for Vitamin B12(ELISA Kit) From LONDON HEALTH company.

We used kit for GOT/GPT( Human Aspartate aminotransferase, GOT/GPT ELISA Kit) From MyBio-Source company. [12]

RESULTS AND DISCUSSION

Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are enzymes mostly located in the liver, although they can also be found in red blood cells, heart cells, muscle tissue, and other organs including the pancreas and kidneys. AST and ALT, previously known as serum glutamic oxaloacetic transaminase (GOT) and serum glutamic pyruvic transaminase (GPT) respectively.

Glutamic pyruvic transaminase (GPT) is referred to as GPT. Elevated AST or ALT readings are generally used as a helpful tool for diagnosing liver disease. While not exclusively applicable to liver illness, it can be utilized in conjunction with other enzymes.[13]

• •    Normal value for S.GPT UP To 41U/L

• • Normal value for S.GOT UP To 46U/L

• • Normal value for Vitamin B12 UP To 180- 800 pg/ ml.[14]

The results that appeared show lower concentrations of vitamin B12 and decreased liver function in pediatric patients who use nitrous oxide gas as an anesthetic in dental clinics compared to children who do not use nitrous oxide gas as an anesthetic. Which results in low vitamin concentrations, which leads to nerve dysfunction, damage to the spine, and other pathological causes.[15]

Table -1

Show the values of parameters for Group Patients undergoing anesthesia By N2O – and Group Patients undergoing anesthesia without N2O

Parameters	Patients undergoing anesthesia By N2O	Patients undergoing anesthesia without N2O
Mean S.GPT (Alanine Aminotransferase)	21U/L	42 U/L
Mean S.GOT (Atsparte Aminotranferase)	24 U/L	47 U/L
Vitamin B12 (Cyanocobalamine)	290 pg/ml	600 pg/ml

Figure -1 show the values of parameters for Group Patients undergoing anesthesia By N2O- and Group Patients undergoing anesthesia without N2O

Nitrous oxide and its relationship to anesthesia In 1844, a dentist named Horace Wells attended a public demonstration of nitrous oxide (N2O), after seeing an advertisement that said, “Those who have once inhaled the gas are always eager to inhale again.[16]/ No language can do “That” described the resulting euphoric sensation. Wells later had one of his teeth extracted by a fellow dentist under N2O and was so impressed that he experimented on several patients before presenting his new discovery at Harvard. Although this was a failure – “nonsense” – nitrous oxide anesthesia quickly became popular in most parts of the world. Unlike the fate of other anesthetic gases introduced later, such as chloroform and ether, N2O still has a central role in current anesthesia practice. Despite some authoritative opinions to the contrary1,3, a recent study of anesthetists in Great Britain found that [17] It has been found that when used in dental treatment, N2O/O2 inhalation serves any of the goals such as reducing or eliminating fear and anxiety regarding dental surgical procedures, promoting a positive attitude, encouraging subsequent dental care, reducing pain reactions to such jaw and dental surgery, and controlling the patient’s movement during treatment, i.e. Gas anesthesia treatment has positive indications and encouragement as a remover of anxiety and fear, especially for patients who have anxiety disorders, tension, or hypersensitivity to dental treatment. It is very important for children and dental surgeries.[18]

CONCLUSION

It was found that taking doses of nitrous oxide gas, which is used as an anesthetic, or in abnormal doses, leads to lowering the natural levels of this important vitamin B12 due to its importance for many functions in the body.