Nitrous Oxide Sedation – Everything You Need To Know
By inhalation sedation, the patient experiences substantial pain relief. Contact with the patient is maintained at all times – it is essential for your own safety. Controlling the dose of nitrous oxide by deepening or reducing the depth of sedation as needed is virtually effortless. N2O effectively minimizes the patient’s anxiety. Laughing gas helps you become more calm, passive, indifferent to the surrounding reality. Children also have an unusual tendency to dream. They dream of swimming in the water, flying in a plane, balloon, space rocket, or spinning around on a carousel.
What is Nitrous Oxide Sedation?
Nitrous oxide, or inhalation sedation called laughing gas, is a method of reducing stress, anxiety, and pain associated with visiting a dentist in both adults and children. The technique is performed by putting on a small rubber nose mask and inhaling a mixture of nitrous oxide and oxygen. The patient lies in the chair, inhales the gas for a few minutes, goes into a state of physical relaxation, pleasant daze, calm, light anesthesia, which also helps to relieve the gag reflex.
The use of inhalation sedation often results in the so-called retrograde amnesia, which additionally reduces the unpleasant sensations associated with the procedure, especially in the youngest patients. The planned treatment with a mixture of nitrous oxide and oxygen should be performed at least three hours after the last meal. Patients often do not remember the course of the visit.
Sedation with nitrous oxide N2O in children
Before starting the procedure, we perform the preliminary qualification of the child, primarily in terms of age. Inhalation sedation is very rarely successful in children under three years of age due to the lack of cooperation. A piece of vital information is whether the child has been “forcibly” treated with the gas in the past; a specific group of children suffers from a severe psychological trauma that further dental treatment is possible only under general anesthesia.
A child qualified for sedation should not eat at least three hours before the procedure. After obtaining written consent for the treatment, we proceed to familiarize the little patient with the N2O administration apparatus. It is not always possible to get your child’s approval to put a mask on their tiny nose the first time they come for a visit. The treatment may have to be postponed. The process of becoming familiarized with the strange device may take a while, but it’s the best way to avoid traumatizing experiences. Demonstrating and explaining the procedure at home before the dentist’s visit will boost the chances of cooperation on the day of the treatment.
N2O has an anesthetic effect. Many treatments for superficial or even moderate caries (depending on the child’s sensitivity) can be performed without anesthesia. The length of the procedure is then significantly shortened. If the child complains of pain, we stop the procedure and perform anesthesia. Once the appropriate level of sedation is achieved, other pain control measures can be applied.
Is Nitrous Oxide Sedation safe?
Inhalation sedation with nitrous oxide is an extremely safe method that can be used by most people. In the gas mixture administered to the patient, the nitrous oxide content is a maximum of 70%. The remaining 30% is pure oxygen – this is even more than the amount of oxygen in the atmospheric air. In the event of any complications, the treating dentist can give the patient oxygen therapy at any time by shutting off the nitrous oxide supply, which automatically starts the delivery of pure oxygen to the patient. Nitrous oxide contained in the mixture quickly diffuses into plasma through the alveoli; it does not combine with hemoglobin and is not transformed in the body. This gas is present in the blood and tissues on the basis of saturation; therefore, unchanged, it is quickly excreted through the respiratory tract and in a negligible amount through the skin. 95% of nitrous oxide is removed from the body after 5 minutes, and the remaining 5% disappear after another 20 minutes.
Contraindications to the use of sedation with nitrous oxide:
Some of the contraindications to nitrous oxide sedation include:
- Cold, tonsil hypertrophy, and other obstructions of the upper respiratory tract,
- Nasal obstruction
- Chronic Obstructive Pulmonary Disease
- In the first trimester of pregnancy. In subsequent trimesters, only after cleared with an OB/GYN.
- Uncooperative mental disorders,
- Multiple sclerosis, porphyria, myasthenia gravis,
- Bronchiectasis, emphysema,
- Lack of patient cooperation.
Medical conditions for which inhalation sedation is indicated as the method of choice:
- Asthma – N2O does not irritate the respiratory system. Reducing stress reduces the risk of an attack. The breathing mix administered to the patient contains approximately 60% oxygen. It improves breathing efficiency and the patient’s well-being.
- Epilepsy – reducing stress reduces the risk of an attack.
- Heart disease – no effect of N2O on the cardiovascular system. The patient receives an increased concentration of oxygen. More oxygen reaches the coronary vessels. Moreover, the need for oxygen does not increase due to the lack of stress.
- Hypertension – no effect of N2O on the vascular system. Reducing anxiety and stress protects against unexpected increases in blood pressure during the procedure.
- Haemophilia – thanks to the use of N2O, needle pricks can be avoided in some cases.
Properties of nitrous oxide
- It does not cause heart rhythm disturbances.
- There is no apparent impact on the respiratory center.
- It does not irritate the mucosa of the tracheobronchial tree – the system of airways that let air into the lungs.
- It does not cause muscle relaxation.
- It does not accumulate in adipose (fatty) tissue.
- It is eliminated very quickly through the lungs.
- N2O increases the potency of other inhaled anesthetics.
- Increases the potency of codeine.
- N2O does not increase the potency of lidocaine but adds to the analgesic effect.