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

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 a mixture 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  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 problems Inhalation- through breathing/lungs Vomitus Emesis 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  minute/treat_nitrous_broadband.w mv minute/treat_nitrous_broadband.w mv  Do not use nitrous with recovering alcoholics  WRITTEN CONSENT!

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