Expert on why nitrous oxide should be offered for prostate biopsy

In this video, Heidi J. Rayala, MD, PhD, shares the take-home message from the recent Journal of Urology study “Practical Use of Self-Adjusted Nitrous Oxide (SANO) During Transrectal Prostate Biopsy: A Double-Blind Randomized-Control Trial.” Rayala is an assistant professor of surgery at Harvard Medical School in Boston, Massachusetts.

Transcription:

What is the take-home message for the practicing urologist?

I think what's important to think about is that we live in the year 2023, and there are a lot of procedures we do in the ambulatory setting that are painful, and sometimes scary. And I believe that at this point in time, we should be able to offer our patients some options, to at least give them a sense of feeling that they're participating in this procedure, that they have some control over this procedure. I think nitrous oxide can provide that. There may be other options similar to nitrous down the pike, and I look forward to those. And I hope that we'll be able to offer those to our patients as well. I think nitrous oxide has a lot of advantages that make it a very good option right now.

Is there anything you would like to add?

I think that one of the concerns that people may raise about nitrous oxide are deleterious effects to the staff from nitrous oxide or to the environment. I think it's important to understand that the studies that came out on the deleterious effects of nitrous oxide were back in the 70s and the 80s, and perhaps early 90s. All of those systems didn't actually scavenge the nitrous oxide, so the nitrous oxide would come into the room, the patient would breathe it in and breathe it into the room. All of the newer systems now scavenge the gas, so that everything that's breathed out is brought back into the system and evacuated out of the room, so it doesn't have that exposure to the people in the room. I think that's important to understand. It's probably why nitrous fell out of favor for the past 20 or 30 years. But now with these newer systems, I think that's why it's been gaining more popularity. The other concern that you might hear is that nitrous oxide has a negative impact on the environment. Nitrous oxide is a greenhouse gas, but when you actually get into the nitty gritty, the small amount of nitrous that we're using for these procedure is is actually quite miniscule when you look at where most of the nitrous oxide comes from in the environment and from our industry. It's interesting. Studies have shown that when we use nitrous oxide in medicine, most of the nitrous oxide is actually lost in the piping and the manifolds that go through the walls of the hospital. And so most of the systems that we're using in the ambulatory setting have these little e-canister tanks, so they're much smaller. One of those tanks is enough for sometimes 30 to 40 procedures depending on what you're doing. I think the carbon impact of that is probably quite small relative to the alternative of having had to take that patient to the operating room, where there are other gases that are used and certainly a lot more supplies.

This transcription was edited for clarity.