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 Nitrous Oxide/Oxygen Conscious

Sedation in the Pediatric Patient

• Steven Chussid, D.D.S.

 – Columbia niversity School o! Dentaland Oral Surgery

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"ndications

• #educe anxiety

• "ncrease $ain threshold

• Su$$ress gag re!lex

• "ncrease tolerance !or longer a$$ointments

• %liminate need !or sedative $remedication• Potentiate e!!ects o! sedative $remedication

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Physical Pro$erties o!

 Nitrous Oxide

• & non'!lammable, s(eet'smelling gas• #elatively insoluble

• Stable

• Stored in )*% cylinders

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Chemical Pro$erties

•  Nitrous oxide is inert

• +uicly absorbed !rom the alveoli o! the

lungs and $hysically dissolved in the blood

• %liminated unchanged !rom the body

• -as is ra$idly excreted !rom the lungs (hen

the concentration gradient is reversed

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CNS Pharmacology

• CNS de$ressant

• ea anesthetic $otency' &C 01223

• #elatively $otent analgesic

• #es$onse to suggestion enhanced

• Cough re!lex moderately su$$ressed

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#es$iratory %!!ects

• Slight stimulation'resulting in increased

tidal volume

• Sense o! smell decreased

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Di!!usion 4y$oxia

• $on termination o! nitrous oxideadministration, the out$ouring o! o! nitrousoxide into the lungs can dilute the amount

o! oxygen available to the $atient

• 5his danger is $robably insigni!icant inhealthy $atients

• 4o(ever, it is recommended that the $atient receive 1223 oxygen !or 6'7minutes at the termination o! N8O use to $revent $ossibility

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-astrointestinal %!!ects

•  Nausea and 9omiting

 – 9ery lo( incidence

 – sually, no s$ecial eating instructions

 $rior to administration

 – Correlation (ith !luctuatingconcentrations o! N8O:

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#elative Contraindications

• COPD'bronchitis, em$hysema

• #"

• Otitis edia

• Severe emotional disturbances

• Claustro$hobia or irrational !ear o! ;gas<

• axillo!acial de!ormities or nasal obstructions• Pregnant $atients'es$ecially in !irst trimester 

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&dvantages

• #a$id onset and recovery

• %ase o! dose control =titration>

• *imited $hysiologic e!!ects

• &nalgesic

•

Su$$ression o! gag re!lex• Potentiation

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%?ui$ment

•  Numerous ty$es o! machine available

• @ail'sa!e mechanism' minimum 823 O8

• &udible or visual alarm i! O8 interru$tion

• @lush lever 

• Pin'indexed yoe system

• -as cylinders color coded –  -reen'oxygen

 –  )lue'nitrous oxide

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Sa!ety "ssues !or Dental

Personnel• Chronic ex$osure =0A hrs. $er (ee>

 – "ncreases in liver, idney and neurologic

diseases – "ncrease in s$ontaneous abortion

 – "ncrease in congenital abnormalities

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Potential !or &buse

• & real concern in our $ro!ession

• Secure sa!ely

• Common signs o! abuse

 – Parasthesia or clumsiness o! hands and legs

 – *oss o! balance

 – nsteady gait

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Patient Selection

• edical history and $hysical exam

• Parental consent

• ild'moderate anxiety

• Strong gag re!lex

• Ca$acity to be com$liant and !ollo(directions

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&dministration

• Prior to seating $atient

 – ae sure e?ui$ment is set u$ and (oring

 $ro$erly – Select nasal hood o! $ro$er siBe

 – 4ave $atient use restroom i! necessary

 – ae sure you have an assistant

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&dministration'continued

• "ntroduce child to e?ui$ment =slo(ly>'usetell, sho(, do

• ae adustments to ensure mas !itssnugly but com!ortably

• %stablish a total liter $er minute o! gases

!irst (ith 1223 O8 – 6'E liters $er minute de$ending on siBe o!

 $atient

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&dministration'continued

• %ncourage the $atient to breathe through

nose

 – *ight !inger $ressure under lo(er li$

 – 5a$ on nose$iece

 – Fee$ reminding them verbally

• Slo( vs. #a$id induction

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&dministration'continued

• During induction ex$lain (hat the child might be !eeling'use suggestion

 – 5ingling !eeling o! hands and !eet –  Numbness o! li$s and tongue

 – Sensation o! (armth

 – Sensation o! !loating

 – @eeling o! heaviness

 – Droning sounds

 – 4earing distinct but distant

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&dministration'continued

• atch $atient !or signs o! $ro$er level o! sedation

• 5hera$eutic nitrous oxide levels usually bet(een 623'723

• Do NO5 exceed 723

• 9omiting is rare but (atch !or signs o! nausea

• "! $atient does vomit'

 –  DonGt $anic –  5urn head to side

 –  Suction mouth

 –  1223 O8 and com$lete $rocedure

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