PRO-NOX
A system for the purpose of pain and anxiety control during procedures
Indications and contraindications for Administration of Nitrous Oxide for Pain & Anxiety with the PRO- NOX system during Aesthetic Procedures:
Nitrous Oxide is delivered through the PRO- NOX system for the purpose of pain and anxiety control during different procedures.
“PRO- NOX” is a self- administered (under the supervision of medically trained staff), quick onset, fixed 50% nitrous and 50% oxygen pain management system with short duration of effect.
It is generally metabolized and “out of your system” (you are back to normal) within minutes of discontinuing, and therefore you are able to regain complete mental and physical function quickly and drive home”.
Although no severe complications have been reported with this device and type of analgesia, the risks could include headache, euphoria, decreased mental and physical awareness and control, device malfunction and potential overdose, failure of effect, and other unforeseen problems. We have seldom seen any of these problems but are required to disclose them.
*If you have been diagnosed with a severe breathing condition, you
should consult your doctor before using Pro-Nox.
Patients should wait 10 minutes after the last use of nitrous oxide before driving a car or operating any type of machinery.
Using nitrous oxide may make patients unsteady and that if they need to get off the procedure table, they will do so only with assistance.
Patients hold the mouthpiece and inhale the nitrous oxide/oxygen gas mix without assistance from others and only as needed through the procedure to maintain the comfort level.
Nitrous oxide has been safely used throughout the world for pain and anxiety management for many decades, and continues to be used worldwide today.
The risks for nitrous oxide use are the same risks that exist for virtually all other pain-relieving medications that I may choose to use during my procedure.
There are several contraindications for use of Nitrous Oxide through the
PRO-NOX system. They are listed below.
“Recently, among teenagers who misuse nitrogen oxide, there have been reports of Vitamin B deficiency ( especially vitamin B12) and myopathy as the result of overuse of nitrous oxide. Some young people overuse it to get high and then develop neurological symptoms. Abuse means overuse of the laughing gas on a daily basis for months or years.
If you search for ” recreational nitrous oxide abuse” on Pubmed ( The online national library of NIH), you will find over 100 articles. Long-term abuse without timely treatment will eventually lead to irreversible neurological damage. (PMID: 33770366)
Another study showed hyperpigmentation as a rare side effect of nitrous oxide abuse.
” In total, 66 patients (average age: 22.7 ± 4.5 years, 36 males) with neurological disorders due to N2O abuse were included; four of them (17-23 years old, 1 male) manifested skin hyperpigmentation. The duration of N2O abuse of the four patients ranged from 2 to 24 months, and they all had peripheral neuropathy; the two patients also had subacute combined degeneration of the spinal cord. One patient exhibited significant hyperpigmentation throughout the body (trunk, limbs, and face), with no abnormalities in cortisol and other biochemical tests. One patient presented with punctuated pigmentation throughout the trunk. Two patients presented with finger skin pigmentation, especially in the distal phalanxes. Pigmentation after N2O use is remitted slowly with vitamin B12 supplementation.Conclusion: Skin hyperpigmentation is a rare symptom in N2O abusers, which can distribute locally in hands or diffusely throughout the body. Therefore, attention should be paid to a history of N2O abuse and serum vitamin B12 level should be tested.” ( PMID: 31522576)
Another toxicology report : Poison Center medical records from four patients are reviewed in this series. Four patients presented with lower extremity weakness, paresthesias and gait abnormalities in the setting of chronic N2O abuse. Each reported using 50-150 N2O cartridges (“whippets”) almost daily for months to years. ( PMID: 35253567)
Contraindications
- Pregnancy
- Hypersensitivity to nitrous oxide mixtures Artificial, traumatic or spontaneous pneumothorax air embolism
- Middle ear occlusion, ear infection
- Eye Surgery with intraocular gas injection within the last 6 weeks
- Decompression sickness
- Severe abdominal distension secondary to intra-abdominal air /intestinal obstruction
- Vitamin B deficiency such as pernicious anemia, vegan, IBD, malabsorption
- Inability of patient to follow directions
- Inability of patient to hold own delivery device (mouthpiece or mask)
PRO-NOX is not covered by insurance and patients are responsible to pay for the treatment. It costs $95 for up to 15 min use of PRO-NOX during the procedure, every additional use adds $95 for each 15 min until the end of the procedure.
