Nitrous oxide (N2O) is an inhalational medication with few side effects that has anxiolytic, amnestic, potent venodilatory and mild-to-moderate analgesic properties commonly used in the emergency department (ED) setting. Priapism is a serious complication of sickle cell disease (SCD) with few treatment options and an adverse impact on quality of life. Although a 50:50 nitrous oxide/oxygen mix is commonly used in France to enhance analgesia in patients with SCD and vaso-occlusive pain events (VOE) there are no reports of its use to treat priapism. We describe the effects of N2O for the treatment of acute priapism associated with SCD in a pediatric ED.
This is a description of two patients with Hb-SS who presented to the ED with acute priapism that failed oral therapy. On each occasion N2O gas was utilized to help facilitate IV catheter placement.
In each presentation the patients experienced complete resolution of the priapism within 5-15 min of receiving N2O (max 60%). The patients had no recurrence requiring intervention during the subsequent week.
Priapism is a challenging complication of SCD associated with long-term morbidity and a paucity of treatment options. Given the risks and inconsistent results of current recommended therapy N2O may represent a potentially superior treatment option for priapism presenting to the ED that warrants further investigation. Although anecdotal N2O inhalation is an option to consider during a time when a treating ED physician may have few alternatives. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.