Nitrous Ch's 4-7
The raw ingredient _______ _______ is heated to create N2O and water plus a few ingredients: a.) Nitrogen dioxide b.) Dinitrogen monoxide c.) Nitric acid d.) Ammonium nitrate
A
In the Scavenger system, ___ hoses bring fresh gas while ___ hoses evacuate exhaled gas
2, 2
For every tank of N2O used, ____ tanks of Oxygen are used
2.5
O2 makes up approximately _____% of the atmosphere
21%
What is the minimum % flow of oxygen?
30%
Current sedation equipment delivers a minimum of _____% Oxygen. The earth's atmosphere is ____%
30, 20.9
Onset of N2O is rapid. May begin in < _____ secs and reaches peak effects in < ____ mins. Onset parallels IV sedation.
30, 5
N2O/O2 delivery equipment has how many basic parts?
4
The rapid onset of action with N2O/O2 sedation is advantageous. Effects are usually first seen within how many minutes?
5 mins
When receiving N2O, patient recovery is complete after ____ mins of ____ % Oxygen
5, 100
N2O has a physical state of ___% gas and ___% liquid
5, 95
The food industry uses ____% of N2O produced
5-8%
The high pressures of 750 psi in the nitrous tank and 2000 psi in the oxygen tank are reduced to about _____ psi by the pressure reducing valve.
50
Pressure of the N2O cyclinder is constant at ____ psi until almost empty. Not _____ to amount of gas available in the cylinder
750, proportional
______% of N2O produced is used in the health care setting. _______% is used in the hospital setting.
90%, 80-85%
A full cylinder of N2O is likely to be approximately ____% liquid and ____% gas
95, 5
What % of N2O is excreted unchanged through the lungs?
99%
The following are pharmacokinetic characteristics of N2O EXCEPT: a.) Allergy-causing b.) Rapid onset of action c.) relative amnestive d.) Anxiolytic
A
True or False: A patient will not cognitively recover from the N2O/O2 sedation for many hours following its administration. Like all other forms of sedation, every patient must be escorted from the office by a friend or family member following N2O/O2 sedation.
False
True or False: N2O allergies are frequently reported
False
True or False: N2O toxicity is high
False
True or False: N2O/Oxygen sedation can be used as a substitute for local anesthetic
False
O2 gas is pressurized in the cylinder at 750 psi. The O2 gauge will constantly show an accurate amount of gas remaining in the cylinder.
False, True
N2O has a specific gravity of ______. Air has a specific gravity of 1
1.53
The O2 fail-safe device that is required on all N2O/O2 sedation machines ensures that _____ ______ cannot be delivered
100% N2O
Fail Safe Mechanism: prevents _____% N2O delivery A valve opens to allow N2O flow only when there is a flow of oxygen to the system. Any time there is less than _____% oxygen, the nitrous stops flowing.
100, 30
What is the MAC for N2O?
104%
N2O crosses the _____ ______ easily from higher pressure to lower pressure
Alveolar membrane
The raw ingredient ______ ______ is heated to create N2O and water plus a few impurities
Ammonium nitrate
What is the raw ingredient in the manufacturing of N2O?
Ammonium nitrate
Patients report they cannot recall severity or duration of pain or anxiety and the passage of time becomes unclear
Amnestic
The distance from the gas source to the patient's lungs can be lengthened by the conduction tubing and increase the
Anatomic dead space
A drug used to decrease anxiety
Anxiolytic
All of the following are true concerning the scavenging masking EXCEPT: a.) The scavenging mask is standard on all product lines in the US b.) The scavenging mask completely prevents gas from being eliminated through the patients mouth c.) Currents models of scavenging masks significantly reduce the amount of trace N2O in the ambient air d.) The optimum evacuation flow rate of a scavenging mask is 45 L/min
B
If a drug is highly soluble: a.) Equilibrium will be achieved quickly b.) It will diffuse immediately into the blood and be distributed throughout the body c.) The onset of clinical action will be rapid d.) Less drug will be required to achieve equilibrium
B
The optimum scavenger system level in L/min is: a.) 55 L/min b.) 45 L/min c.) 35 L/min d.) 25 L/min
B
The strength of a drug with regard to its ability to achieve a desired effect is termed a.) Efficacy b.) Potency c.) Therapeutic effect d.) Tolerance
B
What is the pressure in a tank of O2 that is approximately 50% full? a.) 700-800 psi b.) 900-1100 psi c.) 1400-1600 psi d.) 1800-2100 psi
B
Pain control with N2O varies due to individual _______
Biovariability
What color tank is N2O in?
Blue
What color tank is nitrogen oxide?
Blue
Conduction tubing connects the ______ to the ______ on the N2O/O2 sedation machine: a.) Oxygen flush button, face mask b.) Regulator, flow meter c.) Flowmeter, nasal hood d.) Tank, flowmeter
C
Nitrous oxide is eliminated through the _____ without any significant biotransformation. a.) Liver b.) Kidneys c.) Lungs d.) Bloodstream
C
The cylinder of _____ is always color-coded blue a.) Hydrogen b.) helium c.) Nitrous Oxide d.) Oxygen
C
The potency of an anesthetic agent indicates how strong or powerful the drug is or how effective it is at producing anesthesia. N2O is the least potent of all inhalation general anesthetics. a.) True, False b.) False, True c.) True, True d.) False, False
C
The use of the scavenging system with N2O sedation is desirable because it: a.) Removes the N2O odor from the room b.) Assists the patient respirations c.) Removes the potentially toxic waste gas from the environment d.) Allows the patient to inhale room air through the nasal hood
C
Hydrocarbons such as oil, grease, or other lubricants should not be used near valves, gauges, regulators, or any fittings on N2O/O2 equipment because they may cause
Catastrophic explosion
Connects several large gas cylinders together (G and H tanks). Allows for transfer of gas supply from one tank to another when the tank is empty. Used when large quantities of gas are needed to supply multiple units
Central System Manifold
Packaging and transport is controlled by
Department of Transport (DOT)
N2O isn't flammable, but it supports ______. For this reason, grease or oil should never be exposed to the gas of the cylinder and it should not be exposed to an open flame.
Combustion
Oxygen isn't flammable but supports ________
Combustion
These tubes deliver the N2O/O2 to the patient
Conduction Tubing
All gas from the manifold travels through precleaned, degreased ______ tubing
Copper
All of the following are true about N2O except: a.) A full tank of N2O contains 95% liquid and 5% gas b.) A full tank of N2O has a pressure gauge reading 750 PSI c.) A tank of N2O is blue d.) The pressure gauge reading is proportional to the gas available in a tank of N2O
D
Nitrous oxide supports combustion; therefore: a.) It is acceptable practice to store N2O gas around lubricants, grease, or oil b.) Tank valves should be opened rapidly c.) The gas itself is flammable d.) If the gas comes in contact with a combustible substance, decomposition of the gas (and potential explosion) may occur
D
What is the function of the nasal hood? a.) It provides a source of additional gas should the patient need it b.) It provides a visual mechanism to monitor patient respirations c.) It delivers N2O and O2 to the patient d.) It holds approximately 3L of gas in the case of an emergency
D
Methionine synthase is vital for the synthesis of ____ and _____ ________
DNA, Cellular reproduction
Prevents incorrect hose attachment
Diameter Safety Index System
What is the chemical name for N2O?
Dinitrogen monoxide
Used when N2O/O2 sedation is not used frequently. The unit houses smaller _____ tanks. Can be moved easily from one location to the other.
E
Provides room air in emergency situation
Emergency Air Inlet
N2O is used in the racing industry to
Enhance engine performance
Manufacturing of N2O is controlled by
FDA
The _____ established Good Manufacturing Practices (GMP) and Quality System Requirements (QSR), resulting in an almost 100% pure product.
FDA
N2O will not be delivered unless O2 is flowing
Fail Safe Mechanism
Manufacturers of N2O/O2 sedation equipment incorporated a ____ ______ oxygen mechanism. Today, it ensures no less than ____% is delivered to the patient
Fail safe, 30
What best describes the amnestic effect associated with N2O/O2 sedation on a patient?
Feeling like less time has passed
After gas pressure in the tank has been reduced, gas is delivered through low-pressure hosing connected to the back of the
Flow Meter
Visual indicator in liters per minute (lpm) of the amount of gas patient is receiving. Sits on top of the yoke stand. Gas flows from cylinders through this part.
Flow meter
Conduction tubing connects the ______ to the _____ on the N2O/O2 sedation machine
Flowmeter, nasal hood
Larger ___ and ___ cylinders are more cost effective for more high frequency use and are used in central supply systems. Portable units use the smaller ___ tanks.
G, H, E
The FDA established _____ and _____ for N2O production
GMP, QSR
There seems to be a _____ _____ for pregnant women, those with poor wound healing, and B12 deficient individuals (pernicious and megaloblastic anemias)
Greater risk
What color tank is Oxygen in?
Green
What color tank is oxygen?
Green
N2O is _______ than air
Heavier
A drug that diffuses immediately into the blood and is rapidly distributed across the body is considered
Highly soluble
Designed to prevent the _____ gas cylinder from being attached to the yoke and is known as the pin index safety system.
Incorrect
N2O is relatively ______ in blood
Insoluble
Care should be taken to avoid _____ or ______ of the conduction tubing, preventing gas flow
Kinking, constriction
N2O comes as a compressed ____ and ____ in a cylinder. It is a gas at room temperature
Liquid, gas
What is the drug most commonly and safely delivered comitantly with N2O and O2 in the dental setting.
Local anesthetic
N2O is eliminated from the body primarily through the
Lungs
Connects the central gas supply to the individual operatories and ensures a constant supply of gas.
Manifold
List 3 items associated with a central gas supply N2O/O2 sedation system
Manifold, Large cylinders, regulator
Nitrous is implicated in the interference of a B12 dependent enzyme called
Methionine synthase
Small balls within the tubes rise and fall according to the amount of gas flowing into the flow meter. The number corresponding to the _____ of the ball indicates the liters of flow per minute of gas delivered to the patient.
Middle
The amount of drug needed to prevent movement in 50% of subjects responding to surgical incision
Minimum alveolar concentration (MAC)
Knowledge of the mechanism through which N2O acts on the _____ _____ is limited
Molecular level
What is the least potent of all inhalation anesthetics?
N2O
What is superior pain and anxiety management?
N2O + LA
N2O replaces ____ in the body
Nitrogen
Prevents exhaled gas from entering the reservoir bag
Non-Rebreathing Valve
This will give the pt 100% O2 immediately
O2 Flush Button
Imprinted with information: the ____ and _____ of the cylinder.
Origin, weight
Gauge for ______ accurately indicates amount of gas present in the cylinder until the cylinder is empty
Oxygen
In an emergency situation, the reservoir bag can be used to provide
Oxygen
When using N2O/O2 sedation, open the _____ tank first
Oxygen
The study of the biochemical and physiologic effects of drugs
Pharmacodynamics
The ________ property of a drug affects its uptake, distribution, metabolism and excretion from the body.
Pharmacokinetic
An attachment configuration for each cylinder to be correctly attached to unit. Specifically arranged metal pins protrude from the yoke, onto which the gas cylinder is fitted.
Pin Index Safety System
Prevents incorrect tank attachment
Pin Index Safety System
The safety device that prevents inadvertent attachment of the N2O cylinder to the O2 yoke on a portable unit is called the
Pin index safety system
This refers to how strong or powerful a drug is or how effectively an agent produces anesthesia
Potency
Cylinders, transportation vehicles, and drivers must meet _____ ______
Prescribed regulations
Administering N2O to an individual with an acute sinus infection may cause an increase in _____ because of the expansive nature of N2O within an air-filled space with a bony enclosure.
Pressure
Necessary to ensure the safe delivery of gas through the equipment and to the patient. Pressure gauges accompany regulators and display gas pressures within the tank
Pressure Reducing Valve
N2O is considered a hazardous material due to
Pressurization
Equilibrium is achieved _______. The blood-brain barrier is crossed ____.
Quickly, rapidly
Reducing pressure from the cylinder to an appropriate level for patient inhalation is accomplished by the
Regulator
The main purpose of this part is to provide a source of additional gas.
Reservoir bag
The reservoir bag is a visual mechanism for monitoring the patient's
Respiration
Nitrous oxide cannot produce profound surgical anesthesia. It is often used during induction of general anesthesia. It promotes the rapid uptake of a more potent general anesthetic gas
Second Gas Effect
N2O is often used during induction of general anesthesia because it promotes the rapid uptake of a more potent general anesthesia agent.
Second gas effect
N2O and O2 hoses are different in ____ and _______ connection to prevent improper gas flow to the machine.
Size, threaded
______ of a drug determines how quickly equilibrium occurs and when clinical action begins
Solubility
Metal gas cylinders are made of alloy ____ or ______
Steel, Aluminum
N2O isn't _____ in the body to any extend. It isn't metabolized by the _____.
Stored, liver
Each of the following is considered an anxiolytic effect of N2O/O2 sedation except one. Which is the exception? -Calm -Tolerant -Relaxed -Comfortable -Stressed
Stressed
For most healthy patients undergoing N2O/O2 sedation, the effects of inactivated methionine synthase are _____ and _______.
Temporary, Insignificant
True or False: The O2 in the N2O molecule is not available for use by the body because N2O doesn't break down in the body.
True
Allows the exact amount of the drug to be delivered
Titration
True or False: The gauge for N2O will show the tank is at 750 psi until it is 1/4 full
True
True or False: There have been no reported allergies to N2O
True
The degree to which a drug causes damage
Toxicity
True or False: Medications like diazepam, meperidine, Midazolam, and hydroxyzine can be safely used with N2O
True
True or False: N2O gas by itself is not flammable. If N2O (oxidizer) comes into contact with a heat source (flame/spark) and a combustible, fire will ensue.
True
True or False: N2O is a colorless, sweet-smelling gas
True
True or False: Oxygen is a odorless, colorless, tasteless gas
True
True or False: The Gas Storage Cylinders, Gas Delivery Portion, Scavenger System, and Nasal Hood are the 4 main parts of N2O delivery system
True
N2O remains _____ in the blood. It doesn't dissolve and doesn't combine with cells or proteins in the blood.
Unchanged
Pressure falls at a _____ rate with use from a full pressure of ______ psi - 2200 psi
Uniform, 2000
The color code for O2 in the US is green; however, the universal color most commonly associated with O2 in many other parts of the world is
White
This is the supporting structure on which the N2O/O2 equipment rests. May hold 2 or 4 tanks and is usually on wheels.
Yoke Stand