|Appearance colorless gas|
Molar mass 44.013 g/mol
Boiling point -88.48 °C
|Related compounds |
IUPAC ID Dinitrogen monoxide
Density 1.98 kg/m³
Melting point -90.86 °C
|Soluble in Water, Sulfuric acid, Ethanol, Ether|
Nitrous oxide laughing gas
Nitrous oxide, commonly known as laughing gas or nitrous, is a chemical compound, an oxide of nitrogen with the formula N
2O. At room temperature, it is a colorless, odorless non-flammable gas, with a slightly sweet taste. At elevated temperatures, nitrous oxide is a powerful oxidizer similar to molecular oxygen.
- Nitrous oxide laughing gas
- Nitrous oxide
- Rocket motors
- Internal combustion engine
- Aerosol propellant
- Recreational use
- Mechanism of action
- Anxiolytic effect
- Analgesic effect
- Euphoric effect
- Neurotoxicity and neuroprotection
- Health hazards
- Mental and manual impairment
- Oxygen deprivation
- Vitamin B12 deficiency
- Fertility reduction
- Prenatal development
- Chemicalphysical risks
- Greenhouse effect
- Ozone layer depletion
- Industrial methods
- Laboratory methods
- Properties and reactions
- Atmospheric occurrence
- Emissions by source
- Biological processes
- Early use
- Anaesthetic use
- As a patent medicine
Nitrous oxide has significant medical uses, especially in surgery and dentistry, for its anaesthetic and analgesic effects. Its name "laughing gas" is due to the euphoric effects of inhaling it, a property that has led to its recreational use as a dissociative anaesthetic. It is also used as an oxidizer in rocket propellants, and in motor racing to increase the power output of engines.
Nitrous oxide occurs in small amounts in the atmosphere, but has been found recently to be a major scavenger of stratospheric ozone, with impact comparable to that of CFCs. It is estimated that 30% of the N
2O in the atmosphere is the result of human activity, chiefly agriculture.
Nitrous oxide can be used as an oxidizer in a rocket motor. This has the advantages over other oxidisers in that it is not only non-toxic, but also, due to its stability at room temperature, easy to store and relatively safe to carry on a flight. As a secondary benefit it can be readily decomposed to form breathing air. Its high density and low storage pressure (when maintained at low temperature) enable it to be highly competitive with stored high-pressure gas systems.
In a 1914 patent, American rocket pioneer Robert Goddard suggested nitrous oxide and gasoline as possible propellants for a liquid-fuelled rocket. Nitrous oxide has been the oxidiser of choice in several hybrid rocket designs (using solid fuel with a liquid or gaseous oxidizer). The combination of nitrous oxide with hydroxyl-terminated polybutadiene fuel has been used by SpaceShipOne and others. It is also notably used in amateur and high power rocketry with various plastics as the fuel.
Nitrous oxide can also be used in a monopropellant rocket. In the presence of a heated catalyst, N
2O will decompose exothermically into nitrogen and oxygen, at a temperature of approximately 1,070 °F (577 °C). Because of the large heat release, the catalytic action rapidly becomes secondary as thermal autodecomposition becomes dominant. In a vacuum thruster, this can provide a monopropellant specific impulse (Isp) of as much as 180 s. While noticeably less than the Isp available from hydrazine thrusters (monopropellant or bipropellant with dinitrogen tetroxide), the decreased toxicity makes nitrous oxide an option worth investigating.
Nitrous oxide is said to deflagrate somewhere around 600 °C (1,112 °F) at a pressure of 21 atmospheres. At 600 psi for example, the required ignition energy is only 6 joules, whereas N
2O at 130 psi a 2500-joule ignition energy input is insufficient.
Internal combustion engine
In vehicle racing, nitrous oxide (often referred to as just "nitrous") allows the engine to burn more fuel by providing more oxygen than air alone, resulting in a more powerful combustion. The gas itself is not flammable at a low pressure/temperature, but it delivers more oxygen than atmospheric air by breaking down at elevated temperatures. Therefore, it is often mixed with another fuel that is easier to deflagrate. Nitrous oxide is a strong oxidant roughly equivalent to hydrogen peroxide and much stronger than oxygen gas.
Nitrous oxide is stored as a compressed liquid; the evaporation and expansion of liquid nitrous oxide in the intake manifold causes a large drop in intake charge temperature, resulting in a denser charge, further allowing more air/fuel mixture to enter the cylinder. Nitrous oxide is sometimes injected into (or prior to) the intake manifold, whereas other systems directly inject right before the cylinder (direct port injection) to increase power.
The technique was used during World War II by Luftwaffe aircraft with the GM-1 system to boost the power output of aircraft engines. Originally meant to provide the Luftwaffe standard aircraft with superior high-altitude performance, technological considerations limited its use to extremely high altitudes. Accordingly, it was only used by specialized planes like high-altitude reconnaissance aircraft, high-speed bombers, and high-altitude interceptor aircraft. It could sometimes be found on Luftwaffe aircraft also fitted with another engine-boost system, MW 50, a form of water injection for aviation engines that used methanol for its boost capabilities.
One of the major problems of using nitrous oxide in a reciprocating engine is that it can produce enough power to damage or destroy the engine. Very large power increases are possible, and if the mechanical structure of the engine is not properly reinforced, the engine may be severely damaged or destroyed during this kind of operation. It is very important with nitrous oxide augmentation of petrol engines to maintain proper operating temperatures and fuel levels to prevent "pre-ignition", or "detonation" (sometimes referred to as "knock"). Most problems that are associated with nitrous do not come from mechanical failure due to the power increases. Since nitrous allows a much denser charge into the cylinder it dramatically increases cylinder pressures. The increased pressure and temperature can cause problems such as melting the piston or valves. It may also crack or warp the piston or head and cause pre-ignition due to uneven heating.
Automotive-grade liquid nitrous oxide differs slightly from medical-grade nitrous oxide. A small amount of sulfur dioxide (SO
2) is added to prevent substance abuse. Multiple washes through a base (such as sodium hydroxide) can remove this, decreasing the corrosive properties observed when SO
2 is further oxidised during combustion into sulfuric acid, making emissions cleaner.
The gas is approved for use as a food additive (also known as E942), specifically as an aerosol spray propellant. Its most common uses in this context are in aerosol whipped cream canisters, cooking sprays, and as an inert gas used to displace oxygen, to inhibit bacterial growth, when filling packages of potato chips and other similar snack foods.
The gas is extremely soluble in fatty compounds. In aerosol whipped cream, it is dissolved in the fatty cream until it leaves the can, when it becomes gaseous and thus creates foam. Used in this way, it produces whipped cream four times the volume of the liquid, whereas whipping air into cream only produces twice the volume. If air were used as a propellant, oxygen would accelerate rancidification of the butterfat; nitrous oxide inhibits such degradation. Carbon dioxide cannot be used for whipped cream because it is acidic in water, which would curdle the cream and give it a seltzer-like "sparkling" sensation.
However, the whipped cream produced with nitrous oxide is unstable and will return to a more liquid state within half an hour to one hour. Thus, the method is not suitable for decorating food that will not be immediately served.
During December 2016, some manufacturers reported shortage of aerosol whipped creams in the United States due an explosion at the Air Liquide nitrous oxide facility in Florida in late August. With a major facility offline, the disruption caused a shortage resulting in the company diverting the supply of nitrous oxide to medical clients rather than to food manufacturing. The shortage came during the Christmas and holiday season when canned whipped cream use is normally at its highest.
Similarly, cooking spray, which is made from various types of oils combined with lecithin (an emulsifier), may use nitrous oxide as a propellant; other propellants used in cooking spray include food-grade alcohol and propane.
Nitrous oxide has been used in dentistry and surgery, as anaesthetic and analgesic, since 1844.
In the early days, the gas was administered through simple inhalers consisting of a breathing bag made of rubber cloth. Today, the gas is administered in hospitals by means of an automated relative analgesia machine, with an anaesthetic vaporiser and a medical ventilator, that delivers a precisely dosed and breath-actuated flow of nitrous oxide mixed with oxygen in a 2:1 ratio.
Nitrous oxide is a weak general anaesthetic, and so is generally not used alone in general anaesthesia, but used as a carrier gas (mixed with oxygen) for more powerful general anaesthetic drugs such as sevoflurane or desflurane. It has a minimum alveolar concentration of 105% and a blood/gas partition coefficient of 0.46.
Dentists use a simpler machine, that only delivers a N
2 mixture for the patient to inhale while conscious.
Inhalation of nitrous oxide is frequently used to relieve pain associated with childbirth, trauma, oral surgery, and acute coronary syndrome (includes heart attacks). Its use during labour has been shown to be a safe and effective aid for birthing women. Its use for acute coronary syndrome is of unknown benefit.
In Britain and Canada, Entonox and Nitronox are commonly used by ambulance crews (including unregistered practitioners) as a rapid and highly effective analgesic gas.
Nitrous oxide has been shown to be effective in treating a number of addictions, including alcohol withdrawal.
Nitrous oxide is also gaining interest as a substitute gas for carbon dioxide in laparoscopic surgery. It has been found to be as safe as carbon dioxide with better pain relief.
Recreational inhalation of nitrous oxide, with the purpose of causing euphoria and/or slight hallucinations, began as a phenomenon for the British upper class in 1799, known as "laughing gas parties".
Starting already in the 19th century, widespread availability of the gas for medical and culinary purposes allowed the recreational use to expand greatly, throughout the world. In the United Kingdom, as of 2014, nitrous oxide was estimated to be used by almost half a million young people at nightspots, festivals and parties.
The legality of that use varies greatly from country to country, and even from city to city in some countries.
Mechanism of action
The pharmacological mechanism of action of N
2O in medicine is not fully known. However, it has been shown to directly modulate a broad range of ligand-gated ion channels, and this likely plays a major role in many of its effects. It moderately blocks NMDA and β2-subunit-containing nACh channels, weakly inhibits AMPA, kainate, GABAC, and 5-HT3 receptors, and slightly potentiates GABAA and glycine receptors. It has also been shown to activate two-pore-domain K+
channels. While N
2O affects quite a few ion channels, its anaesthetic, hallucinogenic, and euphoriant effects are likely caused predominantly or fully via inhibition of NMDA receptor-mediated currents. In addition to its effects on ion channels, N
2O may act to imitate nitric oxide (NO) in the central nervous system, and this may be related to its analgesic and anxiolytic properties.
In behavioural tests of anxiety, a low dose of N
2O is an effective anxiolytic, and this anti-anxiety effect is associated with enhanced activity of GABAA receptors, as it is partially reversed by benzodiazepine receptor antagonists. Mirroring this, animals which have developed tolerance to the anxiolytic effects of benzodiazepines are partially tolerant to N
2O. Indeed, in humans given 30% N
2O, benzodiazepine receptor antagonists reduced the subjective reports of feeling "high", but did not alter psychomotor performance, in human clinical studies.
The analgesic effects of N
2O are linked to the interaction between the endogenous opioid system and the descending noradrenergic system. When animals are given morphine chronically they develop tolerance to its pain-killing effects, and this also renders the animals tolerant to the analgesic effects of N
2O. Administration of antibodies which bind and block the activity of some endogenous opioids (not β-endorphin) also block the antinociceptive effects of N
2O. Drugs which inhibit the breakdown of endogenous opioids also potentiate the antinociceptive effects of N
2O. Several experiments have shown that opioid receptor antagonists applied directly to the brain block the antinociceptive effects of N
2O, but these drugs have no effect when injected into the spinal cord.
Conversely, α2-adrenoceptor antagonists block the pain reducing effects of N
2O when given directly to the spinal cord, but not when applied directly to the brain. Indeed, α2B-adrenoceptor knockout mice or animals depleted in norepinephrine are nearly completely resistant to the antinociceptive effects of N
2O. Apparently N
2O-induced release of endogenous opioids causes disinhibition of brain stem noradrenergic neurons, which release norepinephrine into the spinal cord and inhibit pain signalling. Exactly how N
2O causes the release of endogenous opioid peptides is still uncertain.
In rats, N
2O stimulates the mesolimbic reward pathway via inducing dopamine release and activating dopaminergic neurons in the ventral tegmental area and nucleus accumbens, presumably through antagonisation of NMDA receptors localised in the system. This action has been implicated in its euphoric effects, and notably, appears to augment its analgesic properties as well.
However, it is remarkable that in mice, N
2O blocks amphetamine-induced carrier-mediated dopamine release in the nucleus accumbens and behavioural sensitisation, abolishes the conditioned place preference (CPP) of cocaine and morphine, and does not produce reinforcing (or aversive) effects of its own. Studies on CPP of N
2O in rats is mixed, consisting of reinforcement, aversion, and no change. In contrast, it is a positive reinforcer in squirrel monkeys, and is well known as a drug of abuse in humans. These discrepancies in response to N
2O may reflect species variation or methodological differences. In human clinical studies, N
2O was found to produce mixed responses similarly to rats, reflecting high subjective individual variability.
Neurotoxicity and neuroprotection
Like other NMDA antagonists, N
2O was suggested to produce neurotoxicity in the form of Olney's lesions in rodents upon prolonged (several hour) exposure. However, new research has arisen suggesting that Olney's lesions do not occur in humans, and similar drugs like ketamine are now believed not to be acutely neurotoxic. It has been argued that, because N
2O has a very short duration under normal circumstances, it is less likely to be neurotoxic than other NMDA antagonists. Indeed, in rodents, short-term exposure results in only mild injury that is rapidly reversible, and permanent neuronal death only occurs after constant and sustained exposure. Nitrous oxide may also cause neurotoxicity after extended exposure because of hypoxia. This is especially true of non-medical formulations such as whipped-cream chargers (also known as "whippets" or "nangs"), which are not necessarily mixed with oxygen.
Nitrous oxide at 75-vol% reduce ischemia-induced neuronal death induced by occlusion of the middle cerebral artery in rodents, and decrease NMDA-induced Ca2+ influx in neuronal cell cultures, a critical event involved in excitotoxicity.
The major safety hazards of nitrous oxide come from the fact that it is a compressed liquefied gas, an asphyxiation risk, and a dissociative anaesthetic.
While relatively non-toxic, nitrous oxide has a number of recognized ill effects on human health, whether through breathing it in or by contact of the liquid with skin or eyes.
Nitrous oxide is a significant occupational hazard for surgeons, dentists, and nurses. Because nitrous oxide is minimally metabolised in humans (with a rate of 0.004%), it retains its potency when exhaled into the room by the patient, and can pose an intoxicating and prolonged exposure hazard to the clinic staff if the room is poorly ventilated. Where nitrous oxide is administered, a continuous-flow fresh-air ventilation system or N
2O scavenger system is used to prevent a waste-gas buildup.
The National Institute for Occupational Safety and Health recommends that workers' exposure to nitrous oxide should be controlled during the administration of anaesthetic gas in medical, dental, and veterinary operators. It set a recommended exposure limit (REL) of 25 ppm (46 mg/m3) to escaped anaesthetic.
Mental and manual impairment
Exposure to nitrous oxide causes short-term decreases in mental performance, audiovisual ability, and manual dexterity.
Abusing nitrous oxide can lead to oxygen deprivation resulting in loss of blood pressure, fainting and even heart attacks.
Vitamin B12 deficiency
Long-term exposure to nitrous oxide can cause vitamin B12 deficiency. It inactivates the cobalamin form of vitamin B12 by oxidation. Symptoms of vitamin B12 deficiency, including sensory neuropathy, myelopathy, and encephalopathy, can occur within days or weeks of exposure to nitrous oxide anaesthesia in people with subclinical vitamin B12 deficiency.
Symptoms are treated with high doses of vitamin B12, but recovery can be slow and incomplete.
People with normal vitamin B12 levels have stores to make the effects of nitrous oxide insignificant, unless exposure is repeated and prolonged (nitrous oxide abuse). Vitamin B12 levels should be checked in people with risk factors for vitamin B12 deficiency prior to using nitrous oxide anaesthesia.
A study of women employed as dental assistants found reduced fertility among those exposed to high levels of nitrous oxide.
Several experimental studies in rats indicate that chronic exposure of pregnant females to nitrous oxide may have adverse effects on the developing fetus.
At room temperature (20 °C (68 °F)) the saturated vapour pressure is 50.525 bar, rising up to 72.45 bar at 36.4 °C (97.5 °F)—the critical temperature. The pressure curve is thus unusually sensitive to temperature. Liquid nitrous oxide acts as a good solvent for many organic compounds; liquid mixtures may form shock sensitive explosives.
As with many strong oxidisers, contamination of parts with fuels have been implicated in rocketry accidents, where small quantities of nitrous/fuel mixtures explode due to "water hammer"-like effects (sometimes called "dieseling"—heating due to adiabatic compression of gases can reach decomposition temperatures). Some common building materials such as stainless steel and aluminium can act as fuels with strong oxidisers such as nitrous oxide, as can contaminants, which can ignite due to adiabatic compression.
There have also been accidents where nitrous oxide decomposition in plumbing has led to the explosion of large tanks.
Nitrous oxide has a significant global warming potential as greenhouse gas. On a per-molecule basis, considered over a 100-year period, nitrous oxide has 298 times the atmospheric heat-trapping ability of carbon dioxide (CO
2). However, because of its low concentration (less than 1/1000 of that of CO
2), its contribution to the greenhouse effect is very small, behind those of water vapour, carbon dioxide, and methane. On the other hand, since 38% or more of the N
2O entering the atmosphere is the result of human activity, and its concentration has increased 15% since 1750, control of nitrous oxide is considered part of efforts to curb greenhouse gas emissions.
A 2008 study by Nobel Laureate Paul Crutzen suggests that the amount of nitrous oxide release attributable to agricultural nitrate fertilizers has been seriously underestimated, most of which would presumably come under soil and oceanic release in the Environmental Protection Agency data.
Ozone layer depletion
Nitrous oxide has also been implicated in thinning of the ozone layer. A new study suggests that N
2O emission currently is the single most important ozone-depleting substance (ODS) emission and is expected to remain the largest throughout the 21st century.
Nitrous oxide is prepared on an industrial scale by careful heating of ammonium nitrate at about 250 C, which decomposes into nitrous oxide and water vapour.NH
3 → 2 H
2O + N
The addition of various phosphate salts favours formation of a purer gas at slightly lower temperatures. This reaction can be difficult to control, resulting in detonation.
3 + (NH
4 → Na
4 + 2 N
2O+ 4 H
4 → 2 N
2O + 2 CO
2 + (NH4)2SO4 + 2H
3 + 2 O
2 → N
2O + 3 H
Hydroxylammonium chloride reacts with sodium nitrite to give nitrous oxide. If the nitrite is added to the hydroxylamine solution, the only remaining by-product is salt water. However, if the hydroxylamine solution is added to the nitrite solution (nitrite is in excess), then toxic higher oxides of nitrogen are also formed.NH
3OHCl + NaNO
2 → N
2O + NaCl + 2 H
3 with SnCl
2 and HCl has also been demonstrated:
3 + 8 HCl + 4 SnCl
2 → 5 H
2O + 4 SnCl
4 + N
Properties and reactions
Nitrous oxide is a colourless, non-toxic gas with a faint, sweet odour.
Nitrous oxide supports combustion by releasing the dipolar bonded oxygen radical,[Name?] thus it can relight a glowing splint.
2O is inert at room temperature and has few reactions. At elevated temperatures, its reactivity increases. For example, nitrous oxide reacts with NaNH
2 at 460 K (187 °C) to give NaN
2 + N
2O → NaN
3 + NaOH + NH
The above reaction is the route adopted by the commercial chemical industry to produce azide salts, which are used as detonators.
Nitrous oxide is a minor component of Earth's atmosphere, currently with a concentration of about 0.330 ppm.
Emissions by source
As of 2010, it was estimated that about 29.5 million tonnes of N
2O (containing 18.8 million tonnes of nitrogen) were entering the atmosphere each year; of which 64% were natural, and 36% due to human activity.
Most of the NO
2 emitted into the atmosphere, from natural and antropogenic sources, is produced by microorganisms such as bacteria and fungi in soils and oceans. Soils under natural vegetation are an important source of nitrous oxide, accounting for 60% of all naturally produced emissions. Other natural sources include the oceans (35%) and atmospheric chemical reactions (5%).
The main components of anthropogenic emissions are fertilized agricultural soils and livestock manure (42%), runoff and leaching of fertilizers (25%), biomass burning (10%), fossil fuel combustion and industrial processes (10%), biological degradation of other nitrogen-containing atmospheric emissions (9%), and human sewage (5%). Agriculture enhances nitrous oxide production through soil cultivation, the use of nitrogen fertilisers, and animal waste handling. These activities stimulate naturally occurring bacteria to produce more nitrous oxide.
Among industrial emissions, the production of nitric acid and adipic acid are the largest sources of nitrous oxide emissions. The adipic acid emissions specifically arise from the degradation of the nitrolic acid intermediate derived from nitration of cyclohexanone.
3) to nitrite (NO−
2) and to nitrate (NO−
3) (e.g., Kowalchuk and Stephen, 2001),
3 to NO−
2, nitric oxide (NO), N
2O and ultimately N
2, where facultative anaerobe bacteria use NO−
3 as an electron acceptor in the respiration of organic material in the condition of insufficient oxygen (O
2) (e.g. Knowles, 1982), and
3−oxidizing bacteria and the pathway whereby ammonia (NH
3) is oxidised to nitrite (NO−
2), followed by the reduction of NO−
2 to nitric oxide (NO), N
2O and molecular nitrogen (N
2) (e.g., Webster and Hopkins, 1996; Wrage et al., 2001).
These processes are affected by soil chemical and physical properties such as the availability of mineral nitrogen and organic matter, acidity, and soil type; as well as climate-related factors such as soil temperature and water content (e.g., Mosier, 1994; Bouwman, 1996; Beauchamp, 1997; Yamulki et al. 1997; Dobbie and Smith, 2003; Smith et al. 2003; Dalal et al. 2003).
The emission of the gas to the atmosphere is greatly limited by its consumption inside the cells, by a process catalyzed by the enzime nitrous oxide reductase.
The gas was first synthesised by English natural philosopher and chemist Joseph Priestley in 1772, who called it phlogisticated nitrous air (see phlogiston). Priestley published his discovery in the book Experiments and Observations on Different Kinds of Air (1775), where he described how to produce the preparation of "nitrous air diminished", by heating iron filings dampened with nitric acid.
The first important use of nitrous oxide was made possible by Thomas Beddoes and James Watt, who worked together to publish the book Considerations on the Medical Use and on the Production of Factitious Airs (1794). This book was important for two reasons. First, James Watt had invented a novel machine to produce "Factitious Airs" (i.e. nitrous oxide) and a novel "breathing apparatus" to inhale the gas. Second, the book also presented the new medical theories by Thomas Beddoes, that tuberculosis and other lung diseases could be treated by inhalation of "Factitious Airs".
The machine to produce "Factitious Airs" had three parts: A furnace to burn the needed material, a vessel with water where the produced gas passed through in a spiral pipe (for impurities to be "washed off"), and finally the gas cylinder with a gasometer where the gas produced, "air", could be tapped into portable air bags (made of airtight oily silk). The breathing apparatus consisted of one of the portable air bags connected with a tube to a mouthpiece. With this new equipment being engineered and produced by 1794, the way was paved for clinical trials, which began when Thomas Beddoes in 1798 established the "Pneumatic Institution for Relieving Diseases by Medical Airs" in Hotwells (Bristol). In the basement of the building, a large-scale machine was producing the gases under the supervision of a young Humphry Davy, who was encouraged to experiment with new gases for patients to inhale. The first important work of Davy was examination of the nitrous oxide, and the publication of his results in the book: Researches, Chemical and Philosophical (1800). In that publication, Davy notes the analgesic effect of nitrous oxide at page 465 and its potential to be used for surgical operations at page 556.
Despite Davy's discovery that inhalation of nitrous oxide could relieve a conscious person from pain, another 44 years elapsed before doctors attempted to use it for anaesthesia. The use of nitrous oxide as a recreational drug at "laughing gas parties", primarily arranged for the British upper class, became an immediate success beginning in 1799. While the effects of the gas generally make the user appear stuporous, dreamy and sedated, some people also "get the giggles" in a state of euphoria, and frequently erupt in laughter.
The first time nitrous oxide was used as an anaesthetic drug in the treatment of a patient was when dentist Horace Wells, with assistance by Gardner Quincy Colton and John Mankey Riggs, demonstrated insensitivity to pain from a dental extraction on 11 December 1844. In the following weeks, Wells treated the first 12–15 patients with nitrous oxide in Hartford, and according to his own record only failed in two cases. In spite of these convincing results being reported by Wells to the medical society in Boston already in December 1844, this new method was not immediately adopted by other dentists. The reason for this was most likely that Wells, in January 1845 at his first public demonstration to the medical faculty in Boston, had been partly unsuccessful, leaving his colleagues doubtful regarding its efficacy and safety. The method did not come into general use until 1863, when Gardner Quincy Colton successfully started to use it in all his "Colton Dental Association" clinics, that he had just established in New Haven and New York City. Over the following three years, Colton and his associates successfully administered nitrous oxide to more than 25,000 patients. Today, nitrous oxide is used in dentistry as an anxiolytic, as an adjunct to local anaesthetic.
However, nitrous oxide was not found to be a strong enough anaesthetic for use in major surgery in hospital settings. Being a stronger and more potent anaesthetic, sulfuric ether was instead demonstrated and accepted for use in October 1846, along with chloroform in 1847. When Joseph Thomas Clover invented the "gas-ether inhaler" in 1876, it however became a common practice at hospitals to initiate all anaesthetic treatments with a mild flow of nitrous oxide, and then gradually increase the anaesthesia with the stronger ether/chloroform. Clover's gas-ether inhaler was designed to supply the patient with nitrous oxide and ether at the same time, with the exact mixture being controlled by the operator of the device. It remained in use by many hospitals until the 1930s. Although hospitals today are using a more advanced anaesthetic machine, these machines still use the same principle launched with Clover's gas-ether inhaler, to initiate the anaesthesia with nitrous oxide, before the administration of a more powerful anaesthetic.
As a patent medicine
Colton's popularization of nitrous oxide led to its adoption by a number of less than reputable quacksalvers, who touted it as a cure for consumption, scrofula, catarrh, and other diseases of the blood, throat, and lungs. Nitrous oxide treatment was administered and licensed as a patent medicine by the likes of C. L. Blood and Jerome Harris in Boston and Charles E. Barney of Chicago.
In the United States, possession of nitrous oxide is legal under federal law and is not subject to DEA purview. It is, however, regulated by the Food and Drug Administration under the Food Drug and Cosmetics Act; prosecution is possible under its "misbranding" clauses, prohibiting the sale or distribution of nitrous oxide for the purpose of human consumption.
Many states have laws regulating the possession, sale, and distribution of nitrous oxide. Such laws usually ban distribution to minors or limit the amount of nitrous oxide that may be sold without special license. For example, in the state of California, possession for recreational use is prohibited and qualifies as a misdemeanour.
In New Zealand, the Ministry of Health has warned that nitrous oxide is a prescription medicine, and its sale or possession without a prescription is an offence under the Medicines Act. This statement would seemingly prohibit all non-medicinal uses of the chemical, though it is implied that only recreational use will be legally targeted.
In India, for general anaesthesia purposes, nitrous oxide is available as Nitrous Oxide IP. India's gas cylinder rules (1985) permit the transfer of gas from one cylinder to another for breathing purposes. This law benefits remote hospitals, which would otherwise suffer as a result of India's geographic immensity. Nitrous Oxide IP is transferred from bulk cylinders (17,000 litres [600 cu ft] capacity gas) to smaller pin-indexed valve cylinders (1,800 litres [64 cu ft] of gas), which are then connected to the yoke assembly of Boyle's machines. Because India's Food & Drug Authority (FDA-India) rules state that transferring a drug from one container to another (refilling) is equivalent to manufacturing, anyone found doing so must possess a drug manufacturing license.