What is the controversy regarding the use of nitrous oxide?

What is the controversy regarding the use of nitrous oxide?

NO₂ is commonly used to provide amnesia, enhance analgesia, and to reduce the requirements of other inhaled or intravenous agents. When utilized during laparoscopic surgery, operative conditions have the potential to become suboptimal. Air-containing spaces (e.g., bowel loops) con-tain approximately 78% nitrogen and 21% oxygen. Because N₂O is 37 times more soluble in blood than is nitrogen, N₂O diffuses into these spaces faster than nitrogen leaves, result-ing in intestinal distention, potentially impairing surgical access. This becomes of special consideration during the longer, mid/upper abdominal laparoscopic procedures (lysis of adhesions, colon resection). Many gynecologic sur-geons have little difficulty performing lower pelvic surgery with N₂O as a component of the anesthetic.