Nitrous Oxide

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

2-3 minutes

1. 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 to 5

The ideal concentration range of N2O is:

30-50%

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

4 ro 5 L/Min

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

4 tanks

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

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

brute force alcohol and ice or tourniquets

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

euphoria

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

true

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

true

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

true then false

Phobia:

type of anxiety disorder

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

written

fear

you believe something will harm you

Which federal agency oversees the packaging and transportation of gases?

DOT

List three desirable characteristics of nitrous oxide

. Fast onset Analgesic properties rapid recovery and elimination

Patients fall into seven categories as described by the ASA. Nitrous oxide/oxygen sedation is indicated for which classifications?

1 2 3 5

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% n20 cannot be delivered

What is the pressure in a FULL tank of oxygen (O2)?

1800 - 2100 psi

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

1950

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

ADSA

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

What causes diffusion hypoxia? How can it be prevented?

Diffusion hypoxia is caused by a decrease in O2 saturations in the blood. Diffusion hypoxia can be prevented by giving 100% O2 for 3 to 5 minutes after operation.

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

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

Describe the onset and recovery of nitrous oxide/oxygen sedation.

Nitrous oxide/ oxygen sedation has an onset of 30 seconds or less and max of 5 minutes. While it may vary in recovery time per person, recovery is accomplished by inhaling oxygen for five minutes after the stopping of nitrous.

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

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

describe the anatomy/organs involved with the inhalation of N2O (or O2).

Organs involved with the respiratory system include: nose, pharynx, larynx, trachea, bronchi, bronchioles, alveolar ducts, sacs, and alveoli. N20 has a high partial pressure and is quickly diffused into the capillary where as it is different from just normal breathing .

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

Removes any potentially toxic waste gas from the environment

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

Stage 1

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

What is the importance of the scavenging system?

The scavenging system connects to the high speed suction and takes away the excess nitrous. If the scavenging system is not hooked up or turned on it can quickly over sedate the patient.

What is tidal volume? What physical or physiological characteristics affect tidal volume?

Tidal volume is the long volume that represents the normal volume of air between inhaling and exhaling without a lot of effort. Other things that can affect tidal volume could include disease or even exercise.

Define titration and list its advantages.

Titration is the method of administering N2O in incremental amounts until a desired endpoint is accomplished. An advantage of titration would be that it minimizes negative experiences with over sedation and can reveal idiosyncratic reactions early in time.

Name two pieces of equipment on the nitrous oxide and oxygen sedation unit that should be checked for leaks prior to using the equipment

Two pieces of equipment that should be checked for leaks prior to use on the nitrous oxide and oxygen sedation unit is the hoses and the bags or tanks.

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.

List at least six contraindications for the use of nitrous oxide/oxygen sedation.

a. COPD b. Pregnant in the first trimester c. pernicious anemia or B12 deficient d. people who abuse N20 or other drugs e. cystic fibrosis f. upper respiratory infection

Which of the following should be documented in the patient record concerning N2O/O2 sedation?

a. Dose administered Duration of the procedure Post operative oxygenation time

1. Symptoms of neuropathy commonly seen in persons who chronically abuse N2O include all of the following except one. Which one is the exception?

a. Insomnia, acute sensitivity, hyperactivity

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

a. comfortable and relaxed b. aware of surroundings c. responds to directions and gives you feedback d. eyes are less active and look glazed e. acknowledges fear and anxiety

List 5 signs/symptoms of oversedation of N20/02:

a. detachment from environment b. hallucinating or dreaming c. an out of body experience d. floating or flying e. unable to move or talk

Nitrous Oxide tank color

blue

1. 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.

both are true

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.

both 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.

both are true

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

bp pulse and respiratins

How is the scavenging system attached and activated?

by the connector that hooks up the high speed suction on the unit. The hose allows gas to come in and excess out. We activate the tubes and monitor the silver balls as well as the patient.

All of the following can influence an individual's response to pain except one. Which one is the exception?

eye color

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

false

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

false

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

false

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

false

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

false then true

Oxygen tank color

green

As you begin N2O/O2 sedation administration, you deliver 7L/min oxygen while securing the nasal hood to the patient. As the patient inhales, you notice the reservoir bag collapsing. What is your next course of action?

increase flow of oxygen

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

liquid

1. Each of the following are recommendations to assist the sedation of a child and help create an inviting environment, except one. Which one is the exception?

loud areas with multiple noises

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

manifold, large cylinder and a regulator

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

methionine synthase

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

observation and intermittent assessment level of sedation

1. Legal requirements regarding documentation of the sedation procedure are likely to include each of the following except one. Which one is the exception?

patient attire

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

patient with COPD

Name the two types of delivery systems of N2O/O2 that dental offices may use. (2pts)

portable and fixed systems or tanks

List the three purposes of the reservoir bag.

provides source of additional gas Monitors patient's respiration Provides positive O2 pressure

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

sobbing

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

true

1. Informed consent must be obtained from a child's parent or guardian each time nitrous oxide is administered.

true

1. Inhalant abuse can cause asphyxiation and death.

true

1. 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.

true

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.

true

Dr. Horace Wells demonstrated the use of nitrous oxide to students and physicians as pain control while extracting a patient's tooth.

true