Yes, laughing gas is still widely used. Nitrous oxide remains one of the most common sedation tools in dentistry, and its use has expanded significantly in recent years into labor and delivery units, emergency departments, and pediatric care. Far from being outdated, it’s experiencing something of a comeback in settings where patients need fast-acting, short-duration pain relief without the drawbacks of stronger sedation.
Dentistry: The Most Common Setting
Dental offices are where most people encounter laughing gas, and that hasn’t changed. It’s a go-to option for patients who feel anxious about procedures like fillings, crowns, or extractions. In pediatric dentistry specifically, roughly 38% of pediatric dentists use nitrous oxide sedation in their clinical practice. The gas reduces anxiety while keeping patients conscious and responsive, which makes it practical for procedures that require some cooperation from the person in the chair.
Children with special health care needs, including those with autism spectrum disorder or controlled asthma, can often safely receive nitrous oxide with proper screening and monitoring. Oxygen levels are tracked continuously with a pulse oximeter, and the child always breathes a mixture that’s at least 50% oxygen during the procedure.
Labor and Delivery: A Rapid Expansion
One of the biggest shifts in nitrous oxide use has happened in maternity care. In 2011, only three medical centers in the entire United States offered laughing gas during labor. By 2018, more than 500 birthing centers and hospitals had adopted it. That growth reflects demand from patients looking for pain management options beyond epidurals and IV opioids.
Nitrous oxide doesn’t block labor pain as completely as an epidural. What it does offer is something different: a sense of control. Laboring patients hold the mask themselves and breathe the gas only when they want it, which many women describe as helping them relax, feel less anxious, and mentally distance themselves from pain. The gas clears the body quickly, so patients can move freely between contractions. It’s also used as a bridge while waiting for epidural placement, or as a fallback for patients who can’t receive an epidural for medical reasons.
Emergency and Pre-Hospital Care
Nitrous oxide shows up in emergency rooms and ambulances as a fast-acting pain option that doesn’t carry the same risks as opioids. In clinical comparisons, nitrous oxide performs about as well as injectable opioids for pain relief, with no significant difference in pain scores in at least one randomized trial. The key advantage in urgent situations is speed and simplicity: patients can self-administer it immediately, it doesn’t require IV access, and it wears off within minutes.
It also works well as part of a multimodal approach, combined with other pain management strategies rather than used alone. This flexibility makes it useful for a wide range of patients, including children who need quick relief for painful injuries or procedures.
How It Works in the Body
Nitrous oxide produces its calming, pain-dulling effects primarily by blocking a specific type of receptor in the brain that normally transmits excitatory signals. This is a different mechanism than most general anesthetics, which tend to amplify the brain’s inhibitory signals. By dialing down excitatory signaling instead, nitrous oxide reduces pain perception and anxiety while leaving you mostly alert and aware of your surroundings.
The gas enters and exits your bloodstream through the lungs, which is why its effects kick in within a minute or two and disappear just as fast. Once the mask comes off, the sedative typically clears your system in 5 to 10 minutes. Recovery is quick enough that you can drive yourself home after a dental appointment, something that isn’t possible with oral sedatives or IV sedation.
Side Effects and Who Should Avoid It
For most healthy people, laughing gas is very safe in a clinical setting. The most common side effects are mild: brief nausea, dizziness, or a headache. Serious complications are rare when the gas is administered with proper oxygen levels and monitoring.
The more notable risk involves vitamin B12. Nitrous oxide inactivates B12 through oxidation, which disrupts enzymes the body needs for nerve function and DNA synthesis. In a healthy person undergoing a single dental procedure, the impact is too small to matter clinically. But for anyone with an existing B12 deficiency or problems with folate metabolism, even a single exposure can trigger neurological symptoms. People in these categories should be screened before receiving nitrous oxide.
Longer exposures carry greater risk. Research has shown that patients who receive nitrous oxide anesthesia for more than three hours develop measurably higher levels of homocysteine, a marker linked to cardiovascular problems, compared to those with shorter exposures.
Several conditions rule out nitrous oxide entirely:
- Pneumothorax or bowel obstruction: The gas expands trapped air pockets in the body because it moves into closed spaces faster than nitrogen can move out.
- Recent eye or middle ear surgery: The same pressure expansion can damage delicate surgical repairs.
- First trimester of pregnancy: The effect on B12 and folate metabolism poses a risk during early fetal development.
- Severe cardiac disease or pulmonary hypertension: Nitrous oxide can raise pressure in the pulmonary arteries and elevate homocysteine levels.
- Severe psychiatric disorders: The gas can cause hallucinations and vivid dreaming in some patients.
The Environmental Cost
One growing concern about medical nitrous oxide is its climate impact. Nitrous oxide has nearly 300 times the global warming potential of carbon dioxide and persists in the atmosphere for over a century. Some hospital systems have started actively reducing their use of anesthetic gases, including nitrous oxide, as part of sustainability initiatives. This hasn’t led to widespread discontinuation, but it is prompting hospitals to use scavenging systems that capture exhaled gas and to be more deliberate about when and how much they administer.
Recreational Misuse and Legal Status
Outside of medical settings, nitrous oxide has a separate life as a recreational drug, typically inhaled from small metal canisters sold as whipped cream chargers. Deaths linked to recreational misuse are rising steeply, which has pushed some states to act. As of mid-2025, Alabama, California, Michigan, and Louisiana have banned recreational use of nitrous oxide. Other states, including Arizona and Connecticut, prohibit sales to minors. New York has banned the sale of whipped cream chargers to anyone under 21. The sale of nitrous oxide itself remains largely unregulated at the federal level because of its legitimate culinary uses.
The risks of recreational use are fundamentally different from clinical use. Medical administration always mixes nitrous oxide with oxygen and limits exposure time. Recreational users often inhale concentrated gas without oxygen, sometimes repeatedly over hours, which dramatically increases the risk of B12 depletion, nerve damage, oxygen deprivation, and loss of consciousness.