Funtabulously Frivolous Friday Five 320

Nitrous Oxide

Horace had gone to see the show exhibiting nitrous oxide put on by the American showman (and former medical student) Gardner Quincy Colton. Wells noticed at the time that one of the participants injured their leg whilst jumping about under the effects of the nitrous oxide but exhibited no pain. 

The following day Wells invited Colton to his dentistry practice where he himself was given the nitrous, and had a colleague extract one of his teeth.  Wells felt no pain during this procedure and thus began his feverish endeavors in both self experimentation, analgesia and procedural sedation. 

Nitrous oxide itself had been discovered initially in 1772 in England by Joseph Priestley, which he called dephlogisticated nitrous air.  It remained a little known scientific curiosity until being properly developed by Humphry Davy in 1799.  Davy was initially looking to find gaseous cures to various medical ailments.  During his own self experimentation he noticed both the euphoric and analgesic effects of the gas.  Davy’s intuitive comments on the potential use of nitrous oxide as a procedural medication was rapidly overlooked, and the gas went on to become a favorite of parlor parties and carnival shows. It wasn’t until Horace Wells demonstrated its analgesic benefits that it properly emerged in the context we know today. 

References:

• Buslov A et al. Frozen in Time: A History of the Synthesis of Nitrous Oxide and How the Process Remained Unchanged for Over 2 Centuries. Anesth Analg. 2018;127(1):65-70
• The Surprising history of hippy crack – boing boing.net

No

In a prospective, double blinded, randomised trial published June 2020, Warren et al analysed 89 patients randomised to either antacid monotherapy, antacid/lidocaine 2% gel or antacid/lidocaine 2% solution. 

There was nil statistical difference in pain scores at 30 or 60 minutes in any group.  Additionally, patients in the lidocaine arms reported more adverse effects, the most obvious being oral numbness, but also more reports of cough, nausea and dizziness.

These results are very similar to a 2003 study by Berman et al who found the same absence of benefits to adding adjuncts to simple antacids. 

I’ll quote the amazing musician Herbie Hancock:

It’s easy to get sidetracked with technology, and that is the danger, but ultimately you have to see what works with the music and what doesn’t. In a lot of cases, less is more. In most cases, less is more.”

References:

• Warren J et al. Antacid Monotherapy Is More Effective in Relieving Epigastric Pain Than in Combination With Lidocaine: A Randomized Double‐blind Clinical Trial. SAEM 2020. https://doi.org/10.1111/acem.14069
• Berman DA et al. The GI Cocktail is no more effective than plain liquid antacid: a randomized, double blind clinical trial. JEM 2003;25(3):239-244
• First10em – Pink Lady: Whats your worth?

Retinopathy of Prematurity (ROP). 

Stevie Wonder (Born 1950 as Stevland Hardaway Judkins) was born at 34 weeks gestation.  In the 1940s and 50s it was very common to nurse premature babies in high oxygen environments.  

The first to discover the unexpected deletirious effects of the this was Dr T. L. Terry, whom in 1942 described retrolental fibroplasia, later ROP. A growing body of evidence rapidly emerged in clinical cohorts and animal studies that showed positive correlations between increased concentration and duration of oxygen use and the development of ROP.  

As early as 1954, the American Academy of Ophthalmology and Otolaryngology recommended minimizing oxygen use in preterm infants.

Reference:

• Stevie Wonder – wikipedia
• Chu A. ROP: We Just Called To Say We Don’t Love You. Pediatrics. 2013;131(1):189-95
• Terry TL. Fibroblastic Overgrowth of Persistent Tunica Vasculosa Lentos in Infants Born Prematurely. Trans Am Ophthalmol Soc. 1942;40:262-284

40%

Approximately 40% of adults with insomnia also have a diagnosable comorbid psychiatric disorder, most frequently depression. Conditions such as depression or anxiety may be a consequence of, and a risk factor for, disrupted sleep. 

Reference:

• Roth T. Insomnia: Definition, Prevalence, Etiology, and Consequences. J Cli Sleep Med 2007;15(3):S7-10

Tick Paralysis

Tick paralysis in humans is most commonly reported in children aged 1–5 years, although can occur in older children and adults; 2-7 days after tick bite. 

It can present with lethargy and weakness , gait changes (often ataxia), and an ascending symmetrical paralysis.  Slurred speech and depressed deep-tendon and gag reflexes are to be noted.  Ophthalmoplegia and bulbar palsy can occur. 

Reference:

Hall-Mendelin S et al. Tick paralysis in Australia caused by Ixodes holocyclus Neumann. Ann Trop Med Parasitol. 2011;105(2):95-106