P030: The FAN study: intranasal fentanyl and inhaled nitrous oxide for fracture reduction

Introduction: Recently, intranasal (IN) fentanyl and inhaled nitrous oxide/oxygen (N2O) mixture have been increasingly used for procedural sedation and analgesia (PSA) alone or in combination. There is a lack of data on the efficacy of these combined agents. Methods: The objective was to evaluate the efficacy of IN fentanyl and N2O as PSA for the reduction of mildly-to-moderately displaced fractures and dislocations. We performed a prospective, observational cohort study between September 2014 and October 2015. Patients were recruited at CHU Sainte Justine (Montréal) and Royal Children Hospital (Melbourne, Australia). Patients aged 4 to 18 years were eligible if PSA consisted of IN fentanyl and N2O for the reduction of mildly-to-moderately displaced fractures or dislocations. Patients received at least IN fentanyl 1.5 mcg/kg (100 mcg max) and at least a 50/50% mixture of N2O with oxygen. Primary outcome was the efficacy of PSA measured by the patient assigned Facial Pain Scale-Revised (FPS-R). The Face, Legs, Activity, Cry, Consolability (FLACC) scale was also recorded. Depth of sedation was evaluated using University of Michigan Sedation Scale (UMSS). Adverse events were recorded following criteria of the Consensus Panel on Sedation Research of PERC/PECARN. Additional data concerning satisfaction or discomfort were evaluated via questionnaires, and follow-up telephone calls were made to elicit information on adverse events after discharge. Results: A total of 91 patients aged 9.7 ± 3.0 years were enrolled. There was no difference between the median FPS-R score during the procedure compared to before: Median 2 and 2 (median difference 0 [95% CI 0, 0]), respectively. The FLACC score was higher during the procedure than before: Median 4 and 0 (median difference 2 [95% CI 1, 3]). UMSS was 1 (95% CI 1, 2) during the procedure. 42 (46%) patients had adverse events, all mild: vertigo (20%), nausea (16%)]or vomiting (12%). A total of 85/88 (97%) parents and 82/85 (96%) ED physicians would want the same sedation in another procedure. Conclusion: PSA with IN fentanyl and N2O seems effective in our study, as evaluated by patient assigned FPS-R. Patients were minimally sedated. Adverse events were frequent but mild. Overall, parents and medical staff would want the same agents used in another procedure. Thus, PSA with IN fentanyl and N2O appears to be an attractive option for reduction of mildly displaced fractures or dislocations.

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NORMATIZAÇÃO PARA USO DO ÓXIDO NITROSO NA CLINICA ODONTOLÓGICA

DENS ◽

10.5380/rd.v15i2.9264 ◽

2007 ◽

Vol 15 (2) ◽

Author(s):

Grasielle KARPSTEIN ◽

Wilson Kenji SHIROMA

Keyword(s):

Nitrous Oxide ◽

Practice Guidelines ◽

Task Force ◽

Sao Paulo ◽

São Paulo ◽

Very Old ◽

Nitrous Oxide Oxygen ◽

Sedation And Analgesia ◽

American Society ◽

New Look

Apesar do oxido nitroso ser usado há mais de cem anos no mundo inteiro, seu uso no Brasil ainda é restrito a poucos profissionais, a falta de informação causa receio por parte do profissional e também por parte dos pacientes, pois pela pouca divulgação ainda existem muitos mitos envolvendo essa técnica. Apenas há três anos o Conselho Federal de Odontologia baixou uma resolução estabelecendo normas para habilitação do Cirurgião Dentista na utilização de oxido nitroso em consultório na sedação consciente. Antes disso muitos cirurgiões dentistas se beneficiavam de lacunas na Legislação, utilizando-o, não raras vezes, de forma indiscriminada. O presente trabalho tem por objetivo trazer ao conhecimento dos acadêmicos e profissionais de odontologia as novas legislações para utilização do oxido nitroso, promovendo a discussão através de comparação da Resolução do CFO de 2004 e das normas que a secretaria de Saúde do Estado de São Paulo implementou em 2005. Palavras-chave: Oxido Nitroso; Odontologia; Sedação Consciente Referencias Bibliográficas 1. Brasil. Lei nº 5.081, de 24 de agosto de 1966. Regula o exercício da profissão odontológica. Diário Oficial da União, Poder Executivo, Brasília, DF, 26 ago. 1966.2. Ranali J. Óxido nitroso: por que usar. J Assoc Paul Cir Dent. 2001; 36(529):32-5.3. São Paulo (Estado). Secretaria de Estado da Saúde. Portaria CVS nº 11, de 03 de junho de 2003. Dispõe sobre proibição ao cirurgião-dentista em aplicar anestesia geral em consultório, ou qualquer tipo de analgesia, empregando fármacos com potencialidade de anestesia geral. Diário Oficial do Estado, Poder Executivo 2003a; 113(104): 23. Seção 1.4. São Paulo. Secretaria de Estado da Saúde. Portaria CVS nº 14, de 01 de agosto de 2003. Dispõe sobre a revogação da Portaria CVS 11, de 03/06/03 e cria grupo de trabalho para regulamentar o uso de anestésicos inalatórios em odontologia. Diário Oficial do Estado, Poder Executivo 2003b; 113(144): 23. Seção 1.5. Moura, L. C. L; A utilização da sedação consciente com oxido nitroso/oxigenio (N20/02) em Odontologia. 20056. AMERICAN SOCIETY OF ANESTHESIOLOGY TASK FORCE: Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology 96(4):1004, 2002.7. ANDRADE, E.D. (1999). Terapêutica medicamentosa em Odontologia. 1ªed, São Paulo, Artes Médicas.8. ANDRADE, E.D. & RANALI, J. (2004). Emergências Médicas em Odontologia. 2ªed, São Paulo, Artes Médicas.9. MALAMED, S. F. & CLARK, M. (2003). Nitrous Oxide-Oxygen: A new look at a very old technique. Journal of the California Dental Association, 31(5):397-403.10. RANALI, J., RAMACCIATO, J.C., MOTTA, R.H.L. (2004). Biossegurança na sedação inalatória com óxido nitroso e oxigênio. Revista da Associação Paulista de Cirurgiões Dentistas, 58(5): 374-378

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Combined nitrous oxide 70% with intranasal fentanyl for procedural analgosedation in children: a prospective, randomised, double-blind, placebo-controlled trial

Emergency Medicine Journal ◽

10.1136/emermed-2018-207892 ◽

2019 ◽

Vol 36 (3) ◽

pp. 142-147 ◽

Cited By ~ 1

Author(s):

Michelle Seiler ◽

Georg Staubli ◽

Markus A. Landolt

Keyword(s):

Nitrous Oxide ◽

Adverse Events ◽

Scale Score ◽

Controlled Trial ◽

Analgesic Efficacy ◽

Pain Scale ◽

Double Blind Study ◽

Double Blind ◽

Significant Group ◽

Registration Number

ObjectiveNitrous oxide 70% (N2O 70%) is an excellent medication for procedural analgosedation (PAS), yet the limit of its analgesic power remains uncertain; therefore, a combination with intranasal fentanyl (INF) was suggested. However, this combination seems to result in a higher rate of vomiting and deeper sedation. This study aimed at assessing the analgesic efficacy, sedation depth and rate of adverse events of PAS with N2O 70% with and without INF.MethodsPatients aged 2–16 years who qualified for PAS with N2O 70% were randomly assigned to receive either INF or placebo prior to N2O inhalation in this randomised, double-blind study, which was performed in a tertiary children’s hospital ED between September 2015 and October 2017. Behaviour during the procedure was evaluated using the Face, Leg, Activity, Cry and Consolability (FLACC) scale and the Modified Behavioural Pain Scale (MBPS); analgesic efficacy was assessed with a self-reported pain scale. Sedation depth using the validated University of Michigan Sedation Scale and adverse events in the ED and during the following 12 hours were documented.ResultsA total of 402 patients were included; 3 did not tolerate N2O and therefore had to be excluded. Overall, 399 patients were analysed, of whom 201 (50.4%) received INF. No significant group differences with regard to FLACC scale score, self-reported pain, MBPS score and sedation depth were found. In addition, the two groups did not differ with regard to all types of adverse events.ConclusionCombining N2O 70% with INF resulted in no differences with regard to FLACC scale score, self-reported pain, MBPS score, patient and parental satisfaction rate, sedation depth, and adverse events.Trial registration numberNCT02533908

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Practice Patterns and Adverse Events of Nitrous Oxide Sedation and Analgesia: A Report from the Pediatric Sedation Research Consortium

The Journal of Pediatrics ◽

10.1016/j.jpeds.2015.10.019 ◽

2016 ◽

Vol 169 ◽

pp. 260-265.e2 ◽

Cited By ~ 21

Author(s):

Daniel S. Tsze ◽

Michael D. Mallory ◽

Joseph P. Cravero

Keyword(s):

Nitrous Oxide ◽

Adverse Events ◽

Practice Patterns ◽

Sedation And Analgesia ◽

Pediatric Sedation ◽

Research Consortium

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Preprocedural Fasting State and Adverse Events in Children Receiving Nitrous Oxide for Procedural Sedation and Analgesia

Pediatric Emergency Care ◽

10.1097/01.pec.0000186427.07636.fc ◽

2005 ◽

Vol 21 (11) ◽

pp. 736-743 ◽

Cited By ~ 57

Author(s):

Franz E. Babl ◽

Ardita Puspitadewi ◽

Peter Barnett ◽

Ed Oakley ◽

Maureen Spicer

Keyword(s):

Nitrous Oxide ◽

Adverse Events ◽

Procedural Sedation ◽

Fasting State ◽

Procedural Sedation And Analgesia ◽

Sedation And Analgesia

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Patient-administered nitrous oxide/oxygen inhalation provides effective sedation and analgesia for colonoscopy

Gastrointestinal Endoscopy ◽

10.1016/s0016-5107(94)70203-9 ◽

1994 ◽

Vol 40 (4) ◽

pp. 418-421 ◽

Cited By ~ 51

Author(s):

Brian P. Saunders ◽

Manabu Fukumoto ◽

Steven Halligan ◽

Tadahiko Masaki ◽

Sharon Love ◽

...

Keyword(s):

Nitrous Oxide ◽

Oxygen Inhalation ◽

Nitrous Oxide Oxygen ◽

Sedation And Analgesia ◽

Effective Sedation

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Use of nitrous oxide‐oxygen inhalation sedation in the COVID‐19 era

International Journal of Paediatric Dentistry ◽

10.1111/ipd.12745 ◽

2021 ◽

Vol 31 (3) ◽

pp. 433-435

Author(s):

Kunal Gupta ◽

Dimitrios Emmanouil ◽

Amit Sethi

Keyword(s):

Nitrous Oxide ◽

Inhalation Sedation ◽

Oxygen Inhalation ◽

Nitrous Oxide Oxygen

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Infusions of propofol to supplement nitrous oxide-oxygen for the maintenance of anaesthesia.

Anaesthesia ◽

10.1111/j.1365-2044.1988.tb09062.x ◽

1988 ◽

Vol 43 (s1) ◽

pp. 18-22 ◽

Cited By ~ 17

Author(s):

J. W. SEAR ◽

I. SHAW ◽

A. WOLF ◽

N. H. KAY

Keyword(s):

Nitrous Oxide ◽

Nitrous Oxide Oxygen

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A clinical trial of efficacy and safety of inhalation sedation with a 50% nitrous oxide/oxygen premix (Kalinox™) in general practice

Clinical Oral Investigations ◽

10.1007/s00784-011-0550-y ◽

2011 ◽

Vol 16 (2) ◽

pp. 633-642 ◽

Cited By ~ 15

Author(s):

Martine Hennequin ◽

Valérie Collado ◽

Denise Faulks ◽

Serge Koscielny ◽

Peter Onody ◽

...

Keyword(s):

Clinical Trial ◽

General Practice ◽

Nitrous Oxide ◽

Efficacy And Safety ◽

Inhalation Sedation ◽

Nitrous Oxide Oxygen

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Does the sedation regimen affect adverse events during procedural sedation and analgesia in injection drug users?

CJEM ◽

10.2310/8000.2013.130933 ◽

2013 ◽

Vol 15 (05) ◽

pp. 279-288 ◽

Cited By ~ 2

Author(s):

Frank Xavier Scheuermeyer ◽

Gary Andolfatto ◽

Hong Qian ◽

Eric Grafstein

Keyword(s):

Adverse Events ◽

Injection Drug Users ◽

Drug Users ◽

Vital Signs ◽

Injection Drug ◽

Procedural Sedation ◽

Secondary Outcome ◽

Procedural Sedation And Analgesia ◽

Pearson Coefficient ◽

Sedation And Analgesia

ABSTRACT Objectives: Injection drug users (IDUs) often undergo procedural sedation and analgesia (PSA) as part of emergency department (ED) treatment. We compared adverse events (AEs) using a variety of sedation regimens. Methods: This was a retrospective analysis of a PSA safety audit in two urban EDs. Consecutive self-reported IDUs were identified, and structured data describing comorbidities, vital signs, sedation regimens (propofol [P], propofol-fentanyl [PF], fentanyl-midazolam [FM], ketofol [1:1 ketamine:propofol, KF], and ketamine-propofol [KP]) and AEs were collected. The primary outcome was the proportion of patients in each sedation group having an AE; the secondary outcome was the proportion of patients having a cardiovascular or respiratory AE. Results: Data were collected on 276 IDUs (78 P, 82 PF, 65 FM, 25 KF, and 26 KP), and 18 patients had AEs (6.5%, 95% CI 4.0–10.3). The AE rates were 0.0%, 8.5%, 9.2%, 12.0%, and 7.6%, respectively, with propofol having a significantly lower rate (Pearson coefficient 14.9, p = 0.007). The cardiovascular/respiratory AE rates were significantly different as well, with P, KP, and KF having the lowest rates (Pearson coefficient 13.3, p = 0.01). Conclusions: For IDU PSA, the overall AE rate was 6.5%, and propofol appeared to have a significantly lower rate.

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