Safety of nitrous oxide administration in patients with CMT disease

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J Neurol Sci. 2007 Dec 29

Safety of nitrous oxide administration in patients with Charcot-

Marie-Tooth disease.

Isbister GK, Burns J, Prior F, Ouvrier RA.

Clinical Pharmacology, The Children's Hospital at Westmead/Tropical

Toxinology Unit, Menzies School of Health Research, Darwin

University, Darwin, Australia.

Nitrous oxide is routinely administered to children and adults with

Charcot-Marie-Tooth disease (CMT) as an anaesthetic for procedures

such as nerve conduction studies and maintenance for general

anaesthesia. However it is listed as a 'moderate to significant'

risk of potential toxicity and worsening neuropathy in people with

CMT by the CMT Association (USA), CMT Association of Australia, CMT

International (Canada) and CMT United Kingdom. We performed a

systematic review focussing on the use of nitrous oxide in patients

with CMT to help clarify its safety. This identified 11 studies

reporting 41 exposures to therapeutically inhaled nitrous oxide as

maintenance for general anaesthesia with no reports of adverse

effects or worsening of CMT neuropathy. In the absence of a single

case in the literature reporting worsening neuropathy in CMT

patients receiving nitrous oxide, this review provides good evidence

that nitrous oxide should be considered a safe agent for use in

children and adults with CMT.