nitrous oxide

In what decade was inhalation sedation introduced in the dental school curriculum?

1950's

How many minutes should a patient be allowed to breathe oxygen prior to administering nitrous oxide

2-3 minutes

The initial flow of O2 in liters per minute (L/min) for a child between three and five years of age should begin between

3-5

The ideal concentration range of N2O is

30%-50%

The average flow rate of oxygen (O2) for a child is

4-5 L/min

What is the pressure in a FULL tank of nitrous oxide (N2O)?

650-900 psi

What is the pressure of a HALF-FULL tank of N2O?

650-900 psi

What is the pressure of a HALF-FULL tank of O2?

900-1100 psi

Allowing a child to fall asleep under Nitrous Oxide and Oxygen Sedation (N2O/O2) is considered safe.T/F

False

It is acceptable to leave the patient alone when administering N2O/O2 sedation T/F

False

The liver is the organ that is responsible for the metabolism of nitrous oxide. T/F

False

What is the word for "pain" in Spanish?

dolor

What was Humphrey Davy's first experience/reaction to inhaling pure N20?

euphoria

Nitrous oxide is a sweet smelling, colorless gas and is nonflammable. T/F

true

A full nitrous oxide cylinder contains 5% liquid and 95% vapor. T/F

False

Which federal agency oversees the packaging and transportation of gases?

DOT

What percentage of nitrous oxide is suggested to begin administration of nitrous oxide and oxygen sedation on an adult patient

10-15%

The most important safety feature of the unit is the oxygen fail-safe mechanism that is required on all N2O/O2 sedation machines, ensures that:

100% N2O cannot be delivered

What is the pressure in a full tank of O2

1800-2100 psi

List three desirable characteristics of nitrous oxide

A. Has the ability to raise the patient's pain threshold B. It can reduce a patient's anxiety over the treatment and provide a sense of well being C. It has a rapid onset and it doesn't remain in the body long after administration has been stopped

Which of the following should be taken into consideration when using nitrous oxide?

A. No hydrocarbon compounds (such as grease, oil or other lubricants) should be used on the equipment. B. If the gas is exposed to high temperature/pressure, an explosion could occur. C. Nitrous oxide should never be used without oxygen.

Which of the following is the appropriate procedure to follow when a patient indicates he/she is still dizzy following the initial five minutes of postoperative 100% oxygen

Administer an additional five minutes of 100% oxygen and reassess

Which organization established the guidelines for teaching pain and anxiety control in dentistry and is still active today in research and education?

American Dental Society of Anesthesiology (ADSA)

What is tidal volume

Amount of gas inspired into lungs

The blood-gas partition coefficient is a measurement of how easily an agent (nitrous oxide) will cross the pulmonary membrane and enter the blood stream. Nitrous oxide has a blood-gas partition coefficient of 0.47. T/F

Both statements are true

The titration method of N2O/O2 is recommended for use with children. Rapid induction is the technique in which high concentrations are administered at the outset and is practiced by some disciplines such as pediatric dentistry T/F

Both statements are true

There is a spectrum of pain and anxiety management that ranges from no intervention and ends with general anesthesia. Inhalation sedation (N2O/O2) alone is considered a conscious depth of anesthesia. T/F

Both statements are true

Which of the following methods of pain control were used in the early 19th century?

Brute force, alcohol or opium, tourniquets or ice

contraindications for use of N2O

COPD (chronic obstructive pulmonary disease) Pregnancy reality altering mental disorders

Name the two types of delivery systems of N2O/O2 that dental offices may use.

Central supply Portable system

Who suggested the use of oxygen with nitrous oxide in order to keep the blood oxygenated?

Dr. Andrews

Who was responsible for training 6,000 dentists in N2O/O2 sedation and in 1968 published a textbook on nitrous oxide inhalation analgesia?

Dr. Langa

Which federal agency regulates the Nitrous Oxide industry

FDA

List two requirements of the clinician when monitoring a child who is being minimally sedated (less than 50% nitrous oxide)

Frequent verbal contact Watching inhalation/exhalation via reservoir bag

Nitrous oxide/oxygen sedation is indicated for which classifications of ASA

I, II, and III

Which of the following is true concerning N2O?

It may induce nerve damage of used chronically

Who is credited for discovering nitrous oxide?

Joseph Priestly

In what form is nitrous oxide is stored in the cylinder tank which is ready to use for sedation?

Liquid

What is the propellant used in aerosol whipping cream cans

N2O

Which of the following patients would NOT be a good candidate for the use of N2O?

Patient with chronic obstructive pulmonary disease

The use of scavenging system with N2O sedation equipment is desirable because it:

Removes any potentially toxic waste gas from the environment

The pulse oximeter uses light wavelengths to measure the amount of oxygen saturation of arterial blood. A reading of 88 would be considered normal for a health patient. T/F

The first statement is true; the second statement is false.

Each of the following is a sign of appropriate sedation seen in a child, except one. Which one is the exception

Sobbing

In the monitoring the use of N2O, the patient should be in which stage of general anesthesia

Stage I

Nitrous oxide is a highly soluble drug. It is almost completely eliminated through the lungs. T/F

The first statement is False; the second statement is True.

Which of the following would best escribe the amnestic effect associated with N2O/O2 sedation on a patient?

The patient believes less time passed than was actually spent at the appointment

How many total tanks (both oxygen and nitrous oxide) should be on a portable delivery system?

There should be two tanks of each so there is a backup tank, so there should be four tanks in total.

method of administering a drug in incremental amounts over time until a desired endpoint is reached

Titration

According to published articles and surveys, there is a higher percentage of pediatric dentists who use nitrous oxide/oxygen sedation in clinical practice than those in general practice. T/F

True

Dr. Horace Wells demonstrated the use of nitrous oxide to students and physicians as pain control while extracting a patient's tooth. T/F

True

Informed consent must be obtained from a child's parent or guardian each time nitrous oxide is administered T/F

True

Inhalant abuse can cause asphyxiation and death T/F

True

Nitrous oxide was used as a social drug before being researched to use for pain control. T/F

True

Oxygen is stored as a gas in the tank and as the gas is consumed the dial/gauge changes proportionally. T/F

True

The definition of "direct supervision" found in a state's medical or dental practice act regarding the administration of N2O/O2 by an auxillary would indicate the mandatory presence by a physician or dentist T/F

True

Which of the following would be an appropriate example of the recommended titration technique

Wait to administer a subsequent dose until there is sufficient time to evaluate the effects from the preceding dose.

Informed consent for N20/02 sedation should be obtained each time it is administered. It is recommended that ____________ consent be acquired

Written

List the three vital signs that should be recorded pre-operatively and postoperatively when using nitrous oxide/oxygen sedation

a. Blood pressure b. pulse Respirations

Research studies claim chronic exposure to N2O can inhibit which vitamin B12 dependent enzyme

a. Methionine synthase

Symptoms of neuropathy commonly seen in persons who chronically abuse N2O include

a. Unsteady gait, clumsiness b. Tingling and/or paresthesia in extremities c. Impaired psychomotor function and dexterity

List 5 signs/symptoms of appropriate N20/02 sedation

a. eye movement slowed, and glassy b. relaxed c. flushed cheeks d. flat facial expression, relaxed smile E. full awareness

List 5 signs/symptoms of over sedation of N20/02:

a. eyes fixed and non-responsive b. uncontrolled laughter c. unaware of their surroundings d. uncomfortable agitated feeling e. floating feeling, out of body experience, hallucinations

an uneasy feeling of discomfort or dread accompanied by an autonomic response; a feeling of apprehension caused by an anticipation of danger

anxiety

What causes diffusion hypoxia

decreased O2 saturated levels in the blood caused by the rapid exit of N2O on its termination can cause diffusion hypoxia.

a feeling of fright or dread rrelated to an identifiable source recognized by the individual

fear

select three items associated with a central gas supply N2O/O2 sedation system.

manifold large cylinder (G,H) regulator

unpleasant sensory and emotional experience associated with actual or potential tissue damage

pain

any persistent and rational fear of something specific, such as an object, activity, or situation that results in avoidance or desie to avoid the feared stimulus

phobia

What physical or physiological characteristics affect tidal volume

size of chest cavity or presence of disease