LA Nitrous Oxide Final
How many liters of air does a healthy adult inhale per minute?
5 to 7
Which of the following best explains the analgesic effect of N2O-O2 sedation?
Opioid
Which is the correct sequence of administration of N2O-O2 sedation?
Patient assessment, obtain consent, assemble armamentarium, pre-sedation preparation, establish tidal volume, initiate sedation, monitor sedation, completion of sedation, documentation
Which of the following is not an indication for use of N2O-O sedation in dentistry?
Patient in the first trimester of pregnancy
What does the reservoir bag monitor?
Patient's respirations
How long is oxygen administered at the completion of sedation?
5 minutes
What will the gauge on an oxygen tank read when it is full?
2200 psi
John Smith is a 64-year-old patient appointed for extraction of #14. He is very anxious but does not want to take any oral sedatives because he has to drive home after the procedure. He mentions that his son had N2O-O2 sedation when his wisdom teeth were removed and he thinks he would like to try it. His health history is significant for heavy smoking over the last 40 years, advanced COPD, hypertension, and diabetes. He walks to the operatory slowly, breathing with great difficulty. 1) What medical condition(s) would contraindicate the use of N2O-O2 sedation? 2) What is the most likely complication of N2O-O2 sedation for Mr. Smith?
Although Mr. Smith has a number of health problems, advanced COPD is an absolute contraindication for the use of N2O-O2 sedation. Mr. Smith has advanced COPD. His breathing is regulated by the drive to breathe when hypoxia is present. The use of N2O-O2 sedation could cause him to cease breathing.
Nitrous oxide is manufactured from
Ammonium nitrate
What is the first thing to do when a patient reports feeling no sedation effects with 50% N2O flow?
Check the patient's breathing
A 31-year-old female presented to the emergency room with a 4-month history of imbalance, limb weakness, and numbness and tingling from her toes to her waist as well as in the hands. She desired immediate medical attention after awakening with complete numbness from the chest to the toes. Physical examination showed decreased pinprick and light touch response from her waist to her toes as well as to her hands. Vibration sensation was also diminished in the feet and hands. Motor examination demonstrated generally decreased strength in all extremities. Magnetic resonance imaging (MRI) revealed no abnormalities although the posterior spinal columns demonstrated increased signal. Standard lab values were normal. The patient did not immediately disclose N2O abuse; however, prior to additional testing the patient admitted to regularly abusing N2O via a N2O machine. Over the last 2 years, she admitted to using N2O for 1-2 hour sessions several times a week. 1) Discuss signs that could have alerted colleagues that this individual might have been abusing nitrous-oxide in the office. 2) Explain the likely cause of the symptoms experienced by this individual. 3) What is the recommended treatment for this individual?
Clinicians or employees who are often found in the facility after hours, or are noticed to frequently lose their balance might be abusing N2O. Chronic abuse of N2O can lead to neurologic disorders due to the reduction in active vitamin B12, possibly through cobalamin inactivation. This individual should be treated with B12 injections to rectify the vitamin deficiency. Additionally she should receive counseling for substance abuse.
Which is the correct calculation to determine the percentages of N2O delivered to a patient per minute?
Divide the liters of N2O per minute by the total liters of flow of N2O and O2 per minute
Which of the following conditions contraindicates the use of N2O-O2 sedation?
Ear Infection
During minimal sedation patients are able to independently and continuously maintain airways; however, they frequently respond slowly to tactile stimulation and verbal commands.
False
In the United States oxygen is stored in blue cylinders, and it is odorless, colorless and tasteless.
False
N2O tanks maintain a constant pressure of approximately 1100 psi until all the liquid has evaporated, making residual volume difficult to determine.
False
Oil, grease, or lubricants can be used on tanks, piping, and regulators during routine maintenance.
False
Patient mouth breathing not only increases the amount of N2O that is available for sedation but also allows N2O to be exhaled into the environment.
False
The incremental induction of N2O should never exceed 5% per three minutes.
False
The nitrous tanks will last significantly longer than oxygen tanks due in part to their gaseous content and the fact that typical administrations deliver only 30% N2O.
False
Which of the following conditions does not contraindicate the administration of N2O?
Hypertension or cardiovascular disease
Which level of sedation is the desired and appropriate level with N2O-O2?
Minimal
Which component of a N2O-O2 delivery system reduces gas pressures from tanks before delivery into tubing and pipes?
Regulator
At least one clinician must remain in a treatment room to monitor a patient during N2O sedation, and at least one additional, appropriately trained professional should be nearby and within view.
True
Average adult tidal volume is 500 mL based on an average of 6-7 liters/minute.
True
Excessive exposure to N2O may occur as a result of leaks from the anesthetic delivery system during administration.
True
Nitrous oxide can also enhance the CNS depressant effects of agents such as barbiturates, tranquilizers, narcotics, and recreational drugs.
True
Nitrous oxide-oxygen sedation has a positive effect on myocardial ischemia due to its provision of supplemental oxygen, sedative properties, and tendency to dilate peripheral vessels.
True
Pin index safety systems are used only for portable equipment.
True
The National Institute for Occupational Safety and Health (NIOSH) set the <KT>maximum exposure limit</KT> for N2O concentration to 25 ppm for dental personnel.
True
The benefits of N2O-O2 sedation include easy titration of gases, rapid onset of sedation, and short recovery time should overdose occur.
True
The pre-induction of sedation begins with establishing tidal volume of 100% oxygen for two minutes.
True