Nitrous oxide analgesia was used in the management of the terminal hospitalization of four adolescents and one child with disseminated cancer. All patients had severe pain that was unresponsive to standard regimens of narcotics and various narcotic analgesia-stimulant combinations. In each case, the addition of nitrous oxide led to an obvious improvement in symptoms of pain, anxiety, and agitation, while simultaneously improving appetite, mood, and the capacity to communicate. There were no side effects except those related to the discomfort of wearing a mask. Acceptance of the procedure by patient, family, and staff was universal and enthusiastic. The procedure is safe, easily administered, and noninvasive. Nitrous oxide can be useful in managing terminal illness refractory to standard pain control measures.