Hi guys
l recently read could it be b12 and it suggests that if we have to have surgery then the normal Nitrox oxide( l think that's what it was) should not be used as it depleats b12 ?
Anyone else heard of this as if that is the case surely we all need it noted on medical files.
🤔
If you are treated for B12 defiency - whether PA or not - it should be on your file.
We have seen quite a number of people who have discussed the issue with the anaesthetist before the operation. (Never having had an operation like that, I do not know quite what happens in the real world.)
The anasethetic is Nitrous oxide - a gas. Seems to be used quite often along with other anaesthetics and in a mixture with oxygen as Entonox, especially when self-administered during labour and birth.
Hi
Thanks for the reply,yes l agree it will be on your file that you have b12 deficiency, however if it is an issue should we not wear a bracelet or something as if it's that bad that it depletes the b12 durning surgery as they suggest and we are in an accident then you won't be able to discuss before hand ?
So far as I am aware, all bracelets and similar approaches are entirely the patient's responsilibity. You could therefore get one if you feel it is appropriate - with whatever special issues it might need to identify.
Certainly, I'd agree that it would have its place for anyone giving themselves frequent injections - otherwise that could easily be missed. After all, a doctor seeing that the last injection was two months ago might well assume that there is another month to go. When the reality is that weekly, or even more frequent, injections have been found necessary.
as Foggyme mentions below problem with nitrous oxide is that it is a super-oxidiser when it comes to cobalamin and renders them totally inactive so the body can't use them.
recreational use of nitrous oxide (laughing gas) is starting to register as a problem in relation to people presenting with B12 deficiency.
Hi Applemac. Yes. you're right. Nitrous oxide should not be given to people suffering from B12 deficency..it is particularly dangerous to those with an undiagnosed B12 deficiency (since any potential consequences go unrecognised and subacute degeneration of the spinal cord can occur).
Nitrous oxide does not deplete B12, rather it renders all B12 inactive.
Some anaesthetists are aware of this, some not. Some anaesthetic departments have containdications in place, some don't. And the same applies to dental surgeries, maternity units, emergency ambulance crews etc. So unfortunately it's pretty hit and miss as to whether health professionals are aware of the potential consequences of giving nitrous oxide to those with B12 deficency. And those with an undiagnosed B12 deficency - of which there could be many - are particularly at risk.
I recently had a procedure where the use of nitrous oxide was a possibility and none of the healthcare professionals were aware of the contraindications relating to it's use. They are now.
So the first thing to say is that there are other anaesthetic gasses that can be used in its place so it's possible to have an anaesthetic without the use of nitrous oxide.
Entanox (laughing gas) also contains nitrous oxide so should be avoided.
It's important if going for a procedure where its use is possible to flag it up to all staff you come into contact with.
A few tips:
Ask for a red alert label to be attached to the wrist clearly stating that no nitrous oxide is to be given.
When signing a consent form write across the top in bold capital letters - No Nitrous Oxide to be Give - B12 Deficiency.
Discuss with the anaesthetist and every pre-op health professional that comes with thirty feet of you.
Take evidence with you just in case they are not aware of the issue (link below with a brief extract - can't access the full paper - pay to view only).
Have a note 'not to be given nitrous oxide' (probably in the allergy section - though of course this is more than an allergy) put in place on your GP, and hospital medical records (should be spotted if admitted there in an emergency). It's not enough to just record B12 deficiency on records because many will not be aware that this means no nitrous oxide.
About a warning bracelet - helvella is right - this is an individual responsibility and there's no reason that you can't do this if you want to. But again, a specific warning 'do not give nitrous oxide' would be best because again, simply flagging a B12 deficency would require knowledge of the issue with nitrous oxide. And this knowledge is not widespread. Unfortunately.
Here's a link to the extract - you can probably find more information on the Internet too:
jamanetwork.com/journals/ja...
NHS Alert about the use of nitrous oxide and B12 deficiency (good to print and take):
gov.uk/drug-safety-update/n...
And this leaves emergency situations...so...making close relatives and friends aware that nitrous oxide should not be given would be a good idea. And there's always that bracelet...
In a perfect medical world all would be well-informed and aware of the potential issues. In a perfect medical world all patient should have their B12 status assessed prior to surgery...and oh how I wish we lived in that medical world...cause then B12 deficency would be understood and we deficients might get appropriate treatment right when it's needed. And however often it's needed 😄
Here's hoping...
👍
Thank you for such a helpful and in depth reply 😊
This subject of anaesthetic has concerned me. Should I be involved in an accident , I do not have any evidence from the NHS that I receive three monthly injections from my GP surgery. Maybe an alert card would be applicable.
Hi all
Thanks for the fantastic response and information, l am going to get a medic card printed to put in my purse l think in the absence of a bracelet, hope l never need to use it but felt it was something to be raised so all are aware 😌
NOX is toxic to B12.
Besides laughing gas, gas and air is given during delivery of a baby, it is also a component of Diesel engine exhaust. In unleaded gasoline cars, the type 2 catalytic converter is supposed to reduce it.
I find I must keep my car air set to recirculate during my long commute to minimize the effects from road pollution.
During these winter months, the defrost setting automatically changed the recirculation setting back to outside air so I get more NOX than I want.
The stress of the commute also consumes B12 so it is like a double whammy.
Every time a friend or family member has surgery, I ask them to discuss an alternate to NOX with the anesthesiologist.
Omg, my dad aged 34 had an operation at Greenwich military hospital in 1984, for duodenal stomach ulcer, we now assume that he had Undiagnosed PA / vitiligo and I (daughter) aged 46 have PA diagnosed in 2013also got vitiligo. The operation was a success, but he had complications after, death certificate said heart failure. I now think it was because of nitrous oxide!!! Medic card for me now!
Hi Eaoz. No. You shouldn't have nitrous oxide if you have B12 deficiency. Nitrous oxide will wipe out every scrap of B12 in your body and even if you have injections immediately to replace it a) the effects of nitrous oxide 'linger' and potentially deactivate the new B12 influx and b) as a consequence it takes time (perhaps too long) to replenish active B12. And being at rock bottom with no B12 at all is a dangerous place to be, even for a very short time.
As there are other anaesthetic drugs that can be used avoiding nitrous oxide is quite easy...😄
👍
Nitrous oxide has a very, very short half life (it's one of the things that make it such a good anaesthetic) so it's effects can't 'linger'. Any new B12 will not be inactivated.
However, a fresh set of loading doses may be needed.
Would it make sense for everyone who has a nitrous oxide anaesthetic to take B12 afterwards? Even those who were B12-replete from diet before the anaesthetic.
If so, what regime of dosing might be appropriate?
If so, isn't about time someone sat up and took notice?
The fact that so many people are exposed to nitrous oxide and so few cases of symptoms of a B12 deficiency being reported in those people makes me suspect that any deficiency will be short-lived in people with sufficient intake and no absorption problems.
Nerve damage will not happen instantly. Nerves are replaced slowly. It will take quite some time with faulty myelin production before any obvious signs manifest.
Blood cell production does have a high turnover. But a few day's low production isn't going to make much difference.
Can non-B12-deficient people recover their B12-replete status in a few days from diet alone?
I'd have thought that if everything goes really well, you might not actually suffer too much. Though you only need some other issues, such as a diet that happens to be low in B12, to fail to achieve repletion.
One particular question is the impact this has in obstetrics where gas and air is treated as if it were purely a placebo without any impact whatsoever. Yet it is a time of phenomenal stress on the woman's body, often loss of blood, and the urgent need to commence lactation.
I stand corrected 😄.
But I'd still say why have it if there is risk when there are other alternatives.
Here's a link warning of neurological toxic effects In the presence of sub-clinical deficiency - after one dose:
gov.uk/drug-safety-update/n...
And here's an extract from medical research paper:
Neurologic Degeneration Associated With Nitrous Oxide Anesthesia in Patients With Vitamin B12 Deficiency
Abstract
Vitamin B12 (cyanocobalamin) is an integral component of two biochemical reactions in man: the conversion of L-methylmalonyl coenzyme A into succinyl coenzyme A and the formation of methionine by methylation of homocysteine. The transmethylation reaction is essential to DNA synthesis and to the maintenance of the myelin sheath by the methylation of myelin basic protein. Active vitamin B12 contains cobalt in its reduced form (Co+). Nitrous oxide produces irreversible oxidation to the Co++ and Co+++ forms that renders vitamin B12 inactive. Five cases (four from the literature and one new case) are presented in which patients unsuspected of having vitamin B12 deficiency developed subacute combined degeneration of the spinal cord following nitrous oxide anesthesia. Patients with vitamin B12 deficiency are exceedingly sensitive to neurologic deterioration following nitrous oxide anesthesia. If unrecognized, the neurologic deterioration becomes irreversible and may result in death.
(Arch Surg. 1993;128:1391-1395)
[Abstract from the JAMA Network]
Here's the link:
jamanetwork.com/journals/ja...
👍
l know l will invest in putting an alert card in my purse until l can get hold of a bracelet or key fob they sell these on e bay etc, l am glad l raised it as l was not aware until l read the book which is worth borrowing from the library or investing in.
I did not want to scare anyone just alert us to the issues it would be nice if the docs and hospital shared info but they don't seem too.
Take care all😊
My daughter had dental surgery in October 2015. At that time we knew she had a low B12 and she was getting once a month B12 injections. We told the dentist about her B12 deficiency but obviously they did not know the ramifications of using nitrous oxide. Within a month of her surgery she was unable to function and her situation became severe. They did not diagnose her PA for another 4 months. When I went back and informed the dentist and anesthesiologist they were unaware of the affects on B12 levels.
B12 absorption post gallbladder surgery
Bariatric Surgery 
GP surgery decides to reduce my injection frequency
self injecting - good news from GP surgery
Depleted B12 after surgery
