DENT 1160 Pharmocology

Nitrous Oxide

HISTORY

Nitrous oxide was originally used as an attraction at science shows.  Horace Wells, attending one these shows, viewed one of the participants using nitrous oxide gas, laughing hysterically even though he had injured a shin, causing a serious wound but without any pain. Hence, he brought this knowledge to dental field offering painless dentistry.  This was considered a major breakthrough in anesthesia. Up until this discovery, dental or medical surgery was performed with no pain control.  The survival of the patient dependent greatly on the speed of the surgeon. 

Wells- entire story at www.trincoll.edu/~aallan/horace.htm

General Info

Nitrous Oxide (laughing gas) is a gas that has been safely used in combination with oxygen for over a century.

Nitrous is always inhaled through a mask which you breath in amixture of nitrous and oxygen gas  

1. WHAT ARE THE EFFECTS?

A lungful of nitrous oxide results in the temporary loss of motor control and a psychological effect, where sensations and perceptions become disconnected

Producing Stage I analgesia or sedation

1. Effects

Users report a dreamy mental state, and may experience mild audio and visual hallucinations.The patient remains conscious. 

2. Equipment needed

Secure Gas tanks- (nitrous N2O and oxygen O2)

flow meter reservoir bag- mix gasses hoses Mask (nosepiece) Scavenger system

3. Legal issues in NE

DA may monitor patient on nitrous but NOT ADMINISTER

DA can take vital signs before, during and after.

4. Tank colors

Oxygen- Green Nitrous- Blue

5. Flow meter

Rate of flow of gas 6-7 liter per min Start O2, grad inc Usually 20-40% Failsafe 70-30 End O2 3-5 min

6. Documentation

Important because ratio is patient specific.

Vitals 3 times Baseline amount (based on patient wt) Time on nitrous Flow volume Time of O2 at end Post op condition of patient

Safety of Nitrous Oxide:

This form of sedative, when used in the dental setting is considered very safe.  Because it is absorbed and removed form the blood steam via the lungs.

Nitrous oxide is completely reversible and hence the patient does not need someone to give them a ride home.

Safety

Work Practices Inspect equipment every day Use scavenging system Instruct patient to refrain from mouth

breathing and talking Bag should collapse and expand as the

patient breathes After administration, flush the system

100% O2. Howard, JADA, March 1997

7. Are there any special instructions for nitrous oxide/oxygen?

Have little or no food before the dental visit. (Occasionally, nausea or vomiting occurs on a full stomach.) If nausea occurs, lower the % of nitrous.

Tell your dentist about any respiratory condition that makes breathing through the nose difficult. It may limit the effectiveness of nitrous oxide/oxygen.

Tell your dentist if you are taking any medication on the day of the appointment

7. Post op

Patient is on O2 for 5-10 minutes at end of procedure

Vitals checked If patient is alert and ready- allow to

leave

No Post Op needed

8. Vocab

Sedation- calming Analgesia- relieve pain Scavenger- remove excess, HVE reproductive problemsInhalation- through breathing/lungsVomitusEmesis bucket

Vocab-

Nasal mask N2O O2

Disposable or patient purchase

Do not wipe down with alcohol

Do NOT use on recovering alcoholics

ALWAYS get written CONSENT

ADA video on nitrous

www.ada.org/public/media/videos/minute/treat_nitrous_broadband.wmv

Do not use nitrous with recovering alcoholics

WRITTEN CONSENT!

The End