Medical Gases: Regulation and Use

Anoop Paruchuri, Y. Achyuth, P. K. Manna and Guru Prasad Mohanta*

Medical gases are those which are manufactured, packaged, and intended for administration to a patient in anesthesia, therapy, or diagnosis. The officially listed therapeutic gases include Oxygen, Helium, Carbon dioxide, Nitrous oxide, Medical air and Nitrogen. These gases are usually given to the pre operated, intra operated and post operated patients and to the patients in case of emergency. These gases are to be supplied in airtight, color coded, well labeled container as required by the respective regulatory authorities of every country or via a central line which runs thru the entire hospital.In spite of all the regulations, precautions put down by the regulatory authorities, there are still reports of medical gas mix ups which even resulted in death of the patients. Even though the mistake done is not intentional it puts the patient’s life at jeopardy. So, eventually who is to be blamed for the mix up, the regulatory authority, the manufacturer, the distributor, the physician or the nurse? Well it is a rhetorical question which still remains unanswered.These reports emphasize the need of regular monitoring from their manufacture until their administration.
Medical Gases
Oxygen, Helium, Carbon dioxide, Nitrous oxide, Medical air and Nitrogen are treated as medical or therapeutic gases (2, 3, 4). Medical Oxygen (1, 2, 3, 4) Listed in U.S.P. 31, I.P. 2007, Eur. P, China, Japan and Viet. The normal air contains 21% of oxygen with a partial pressure of 21kpa at sea level. The inhaled oxygen then enters the alveoli where it dissolves in to the blood and combines with Hemoglobin. Decrease in the partial pressure of Oxygen which happens at high altitudes or presence of any disease states affect the dissolution rate of Oxygen leading to Hypoxia (7, 8). Usually oxygen therapy is given by inhalation to correct hypoxemia and in conditions causing respiratory failure and also in conditions where the oxygen content of the air breathed is inadequate such as high altitude disorders. Oxygen is of value in the treatment of poisoning with a number of substances, including carbon monoxide, cyanides, and dichloromethane. It provides enhanced oxygenation in inhalation injury.
Use and Administration
Oxygen is usually supplied in gas cylinders from which the administration to the patient is done by using a facial mask which can hold about 60% oxygen or through tight fitting anesthetic type mask that can hold up to 100% oxygen. 28-40% oxygen is usually used in treatment of C.O.P.D. and 40-60% is used in case of bronchial asthma and 100% oxygen is usually used in treatment of severe hypoxia and noxious gas poisoning. Usual rate of administration is around 1-15 L/min (7, 8). "Hyperbaric Oxygen therapy" is the administration of 100% oxygen at 1atm pressure for cases like myocardial infraction, cluster headache, stroke and cancer (10). It is widely used in emergencies.



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