Resolution of Acute Priapism in Two Children with Sickle Cell Disease who Received Nitrous Oxide.

Resolution of Acute Priapism in Two Children with Sickle Cell Disease who Received Nitrous Oxide.

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BACKGROUND:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

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