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Title: Formiminoglutamic acid urine excretion : clinical studies in individuals exposed to nitrous oxide
Author: Armstrong, P. J.
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 1994
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A brief history of the discovery of the anaesthetic potential of nitrous oxide is given followed by a more detailed history of the discovery of its specific toxic depressant effect on bone marrow. The work demonstrating that this effect is due to nitrous oxide reacting with vitamin B12 and, consequently, inhibiting methionine synthase is described. As the clinical results of this enzymatic inhibition in inhibiting DNA synthesis are mediated through both the folate and methionine metabolic pathways, these are discussed. Various theories as to how this mediation occurs are contrasted. The clinical relevance of these potential toxic side effects are discussed. Methods of assessing the toxicity of nitrous oxide are analysed and it is concluded that they are either too insensitive or require highly invasive sampling. The use of the formiminoglutamic acid urine excretion test in assessing folate metabolism is appraised and the possibility of using this test to assess nitrous oxide toxicity evaluated. Raised excretion is an index of folate metabolic abnormalities. This thesis then examines the toxicity of nitrous oxide in clinical practice by using this test. Finally, the place of nitrous oxide in modern anaesthesia is discussed.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available