Assessment of hypoxia, sedation level, and adverse events occurring during inhalation sedation using preadjusted mix of 30% nitrous oxide + 70%oxygen

Inhalation sedation (IS) with nitrous oxide (N2O) is classified as minimal sedation. In paediatric dentistry, IS works well for mildly anxious but potentially cooperative children, reducing the need for general anaesthesia for simple dental procedures. We review contemporary guidelines relating to ISN2O in Australasia, the UK, Europe and the US. As this is a multispecialty area, with differences in laws, regulations, guidance and governance from country to country, this review aims to illuminate global trends and assist with the designing of local regulations for the safe practice of ISN2O.

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Assessment of Nitrous Oxide Inhalation Sedation Module in Kuwait: A Survey on Undergraduate Dental Training Curriculum

Advances in Medical Education and Practice ◽

10.2147/amep.s331651 ◽

2021 ◽

Vol Volume 12 ◽

pp. 1309-1315

Author(s):

Mohammad Abdulwahab ◽

Mohammad Kamal ◽

Ahmad M AlAli

Keyword(s):

Nitrous Oxide ◽

Training Curriculum ◽

Inhalation Sedation

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Migraine treated by inhalation sedation using nitrous oxide and oxygen

BDJ ◽

10.1038/sj.bdj.4804451 ◽

1980 ◽

Vol 149 (2) ◽

pp. 54-54 ◽

Cited By ~ 3

Author(s):

A Stanley

Keyword(s):

Nitrous Oxide ◽

Inhalation Sedation

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Prevention of Postoperative Nausea and Vomiting

50 Studies Every Anesthesiologist Should Know ◽

10.1093/med/9780190237691.003.0028 ◽

2018 ◽

pp. 147-152

Keyword(s):

Risk Factors ◽

Nitrous Oxide ◽

Relative Risk ◽

Adverse Events ◽

Postoperative Nausea ◽

Volatile Anesthetic ◽

Postoperative Nausea And Vomiting ◽

Nausea And Vomiting ◽

Baseline Risk ◽

Maximum Reduction

This case focuses on the prevention of postoperative nausea and vomiting (PONV) by asking the question: What is the efficacy of six well-established prophylactic antiemetic strategies individually and in combination for the prevention of postoperative nausea and vomiting? Each of the three antiemetics in this study (ondansetron, dexamethasone, and droperidol) reduced the risk for PONV by approximately 26%; substituting propofol for volatile anesthetic reduced the risk by 19%; and substituting nitrogen (air) for nitrous oxide reduced the risk by 12%. A maximum reduction of 70% in the relative risk for PONV can be expected when total intravenous anesthesia is used with three antiemetics. The appropriate approach to the management of PONV depends on the patient’s baseline risk factors as well as the likelihood of adverse events and costs from the antiemetic medications.

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

CJEM ◽

10.1017/cem.2016.206 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S88-S88

Author(s):

J. Hoeffe ◽

E. D. Trottier ◽

B. Bailey ◽

D. Shellshear ◽

M. Lagacé ◽

...

Keyword(s):

Nitrous Oxide ◽

Adverse Events ◽

Pain Scale ◽

University Of Michigan ◽

Median Difference ◽

Nitrous Oxide Oxygen ◽

Attractive Option ◽

The Face ◽

Observational Cohort ◽

Sedation And Analgesia

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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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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