Medicinal Products

ENTONOX 135 bar 50% / 50%

Generic drug of the therapeutic class: Anesthesia, resuscitation, analgesics
Active ingredients: Nitrous oxide, Oxygen
laboratory: Linde France

Compressed medicinal gas
Bottle (+ manodententeur) of 15 Liters
All forms


· Analgesia during emergency medical assistance: trauma, burns, transport of patients with pain.

· Analgesia of short-term pain in adults and children, including lumbar puncture, myelogram, minor superficial surgery, burn dressings, reduction of simple fractures, reduction of some peripheral dislocations and venipuncture.

· Sedation in dental care, in children, anxious or disabled patients.

· In obstetrics, in a hospital environment only, while waiting for epidural analgesia, or in case of refusal or inability to perform it.

Posology ENTONOX 135 bar 50% / 50% Medicinal gas tablet Bottle (+ manodententeur) of 15 Liters


The flow rate of the mixture is determined by the spontaneous ventilation of the patient.

Administration requires continuous monitoring of the patient. The presence of a third person is recommended

The administration of the mixture must be stopped immediately in case of loss of verbal contact.

The analgesic efficacy of the mixture is fully manifest after at least 3 minutes of inhalation.

The duration of inhalation of the mixture is related to the duration of the act concerned and should not exceed 60 minutes continuously. In case of repetition, it must not exceed 15 days.

When the inhalation stops, the return to the initial state is fast , with no residual effect.

Administration mode

The administration must be done in suitable premises by specially trained medical or paramedical personnel whose knowledge is periodically reassessed (see Warnings and Precautions "Special Warnings" section).

The mixture is administered by means of a face mask adapted to the morphology of the patient, using a specific material approved for this purpose.

Preference is given to self-administration. In order to obtain the full cooperation of the patient, it is necessary to explain to him the purpose and effect of the treatment, as well as its mode of administration.

· Use during painful acts: before performing the act, the mask must be maintained for a period of at least 3 minutes. During this time, verbal contact is maintained with the patient. Inhalation continues for the duration of the act, the patient is asked to breathe normally.

During the administration, the surveillance is essentially clinical: the patient must be relaxed, breathe normally and respond to simple orders: in case of appearance of sedation with loss of verbal contact, the mask will be removed until recovery contact.

· Use in dentistry: a nasal or naso-oral mask can be used, depending on the ventilation mode of the patient.

For patients whose disability does not keep the mask in place, it is maintained by a surgical aid, without strong physical restraint.

After a period of at least 3 minutes, the act can be performed, continuously if a nasal mask is used, or in periods of 20 to 30 seconds when using a naso-oral mask, which will be reassembled on the nose during these periods.

At the end of the treatment, the mask is removed and the patient must rest on the chair for 5 minutes.

· Use in obstetrics: inhalation should begin at the beginning of the contraction, before the onset of pain. The woman should breathe normally during the duration of the contraction, and not hyperventilate because of the risk of oxygen desaturation between contractions. Inhalation will be interrupted as soon as the pain is reduced.

Due to the possibility of oxygen desaturation between contractions, it is desirable to monitor FiO2 continuously for this indication.

Against indications

· Patients requiring ventilation in pure oxygen,

· Intracranial hypertension,

· Any alteration of the state of consciousness, preventing the cooperation of the patient,

· Traumatic brain injury

· Pneumothorax,

· Emphysema bubbles,

· Gas embolism,

· Diving accident,

· Abdominal gas distension,

· Patient who has recently received an ophthalmic gas (SF6, C3F8, C2F6) used in ocular surgery as long as a gas bubble persists inside the eye and at least for a period of 3 months. Serious post-operative complications may occur in connection with increased intraocular pressure.

· Known and unsubstituted vitamin B12 deficiency,

· Neurological abnormalities of recent onset and unexplained.

Adverse effects Entonox 135 Bar

The following side effects may occur during treatment and usually resolve within minutes of stopping inhalation of the mixture.

· Disorders of the nervous system

o Paresthesia,

o Deepening of sedation,

o Modification of sensory perceptions.

o Abnormal movements have been observed most often in a context of hyperventilation.

· Ear and labyrinth disorders

o Dizzying sensations

· Disorders of the digestive system

o Nausea,

o Vomiting

· Psychiatric disorders

o Agitation,

o Anguish,

o Euphoria,

o Dreams

In case of prolonged or repeated exposure:

· Neurological disorders such as myeleuropathies

· Megaloblastic anemias with leukopenia have been reported due to the inhibition of methionine synthetase involved in the synthesis of vitamin B12.

· Cases of abuse and dependence

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