Invited commentary on “Frostbite injuries related to recreational nitrous oxide use: Incidence, management and complications in a Swedish case series”

Liu et al.1 report their experience of nitrous oxide frostbite injury from recreational use in Sweden in 5 out of 9 cases they have treated. This follows similar reports from other parts of Europe2 which describe the pattern of injuries, treatment and issues associated with its (ab)use. The main issue relates to increasing use of larger cylinders, as opposed to the smaller one pictured, which are often held between the thighs and become colder as the nitrous oxide is released. This not only causes cold injury but may also lead to increased use and subsequently greater neurological impact.