MedPage Today reports that nitrous oxide, or laughing gas, is being used as an intermediate option for controlling the pain of childbirth.  Obstetric analgesia has a limited range concentrated at the two extremes: nonmedical tools like massage and hot tubs that make women more comfortable, and epidural infusions that block all feeling below the administration site.  Opioid painkillers are also available but typically don't do much for labor pain.  Specialized equipment fixes the oxygen-to-nitrous oxide ratio at 50/50, and the woman holds the mask in her hand, controlling when and how much anesthetic she gets.  Because the body does not metabolize nitrous oxide, it can be a flexible tool in the delivery room, allowing women, for example, to get up and move around, not an option with an epidural.  Since the use of nitrous oxide does not require an anesthesiologist, the technique holds promise for free-standing birthing centers and other facilities without 24/7 access to those services.  Nurse-midwives are especially interested in its use, and an Internet listserv has been created by Judith Rooks of the American College of Nurse Midwives.  Nitrous oxide is widely used in other parts of the world, but not as much in the United States, where the use of nitrous oxide in childbirth is being evaluated at the University of California at San Francisco and at Dartmouth.  Other facilities, such as the Vanderbilt University Medical Center in Nashville, Tenn., are preparing to offer nitrous oxide due to consumer interest in this additional option for safe patient care.  For the full story, go to http://www.medpagetoday.com/Anesthesiology/PainManagement/26153?utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&userid=324535 .

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