Nitrous Sedation
What is Nitrous Oxide?
Nitrous Oxide in Oral Surgery
Patient anxiety has always been a major issue in dental offices. Dentists have expertise in providing anxiety and pain control for their patients. Although anxiety and pain can be modified by psychological techniques, in many instances pharmacological approaches are required. In children, analgesia/anxiolysis may expedite the delivery of procedures that are not particularly uncomfortable, but require that the patient not move. It also may allow the patient to tolerate unpleasant procedures by reducing or relieving anxiety, discomfort, or pain. The outcome of pharmacological approaches is variable and depends upon each patient’s response to various drugs. The clinical effect of nitrous oxide/oxygen inhalation, however, is more predictable among the majority of the population.
Preinstructions
- The patient should be advised to avoid the heavy meal prior to the use
- The patient is requested to void if necessary, prior to treatment
- Patients with contact lenses should be removed as gas leaks around the bridge of the nose may produce drying of the eyes.
Techniques of Administration
Nitrous oxide – oxygen sedation will always begin and end with the patient receiving 100% oxygen. Then, slowly allowed to breathe. A flow rate of 5–6 L/min generally is acceptable to most patients. The flow rate can be adjusted after observation of the reservoir bag. The bag should pulsate gently with each breath and should not be either over or underinflated. Introduction of 100% oxygen for 1–2 min, followed by titration of N2O in 10% intervals is recommended. During nitrous oxide/oxygen analgesia/anxiolysis, the concentration of N2O should not routinely exceed 50%. Increasing amounts of N2O until the desired effect is achieved. It is important that the patient be reminded to breathe through the nose in order for the gas to work. The patient should be questioned as to how they are feeling to ensure an optimal level of nitrous is being administered. Therapeutic levels will vary from patient to patient. If the nitrous level being administered is too low, the patient will not be receiving an effective anxiolytic dose. If the nitrous level is too high, unwanted side-effects may occur.
Studies have shown that children desaturate more rapidly than adolescents, and administering 100% oxygen to the patient for 3–5 min once the nitrous oxide in a closed system has been terminated is important.
The objectives of nitrous oxide/oxygen inhalation include
- Reduce or eliminate anxiety
- Reduce untoward movement and reaction to dental treatment
- Enhance communication and patient cooperation
- Raise the pain reaction threshold
- Increase tolerance for longer appointments
- Aid in treatment of the mentally/physically disabled or medically compromised patient
- Reduce gagging
- Potentiate the effect of sedatives.
Indications
- A fearful, anxious, or obstreperous patient
- Certain patients with special health care needs
- A patient whose gag reflex interferes with dental care
- A patient for whom profound local anesthesia cannot be obtained
- A cooperative child is undergoing a lengthy dental procedure.
Contraindications
- Chronic obstructive pulmonary diseases
- Severe emotional disturbances or drug-related dependencies
- First trimester of pregnancy
- Treatment with bleomycin sulfate
- Methylenetetrahydrofolate reductase deficiency.
Whenever possible, appropriate medical specialists should be consulted before administering analgesic/anxiolytic agents to patients with significant underlying medical conditions (e.g. severe obstructive pulmonary disease, congestive heart failure, sickle cell disease, acute otitis media, recent tympanic membrane graft, acute severe head injury).
Advantages
- Easy to administer
- Onset of action is rapid
- N2O has bland, pleasant, nonirritating order
- Rapid uptake and elimination of N2O ensures that no hangover effect is experienced
- Recovery is fast
- Titration is possible
- There is a wide margin of safety
- There is cardio-respiratory stability
- Nausea and vomiting are uncommon
- Reflex integrity is maintained
- No preparation of patient is required
- No need for any escort.
Seablue Dental Office FAQ
Everyone’s needs are different, so have a chat to your dentist about how often you need to have your teeth checked by them based on the condition of your mouth, teeth and gums. It’s recommended that children see their dentist at least once a year.
Regular checkups keep you updated with your oral health and help diagnose and timely treatment of any problems developing in your tooth or gums or oral tissues.
You dentist will conduct an exam and x-rays at your dental visits and educate you about your oral health.
Call us at 253-336-3000 or email us at [email protected]
Regular brushing and flossing after every meal should keep the food particles from depositing in crevices of your tooth and hence keeps the harmful bacteria causing the tooth decay in check.
If there is a medical emergency or life threatening condition, call 911 or go to nearest ER.
Sometimes. Contact us for a consultation.
