FEQUENTLY ASKED QUESTIONS REGARDING NITROUS OXIDE AND OXYGEN SEDATION

Can a person with asthma use N2O/O2 sedation?

Absolutely; asthmatics respond very well to N2O. Keeping a patient with asthma from getting anxious is important. N2O is also nonirritating to mucous membranes.

Is there a time limit for the practitioner to consider when administering N2O/O2 sedation?

Although there is no specific time unit, the authors consider 3 hours as an extended time period.

Where can I rent an infrared (IR) spectrophotometer to measure trace gas N2O in my office?

An inexpensive and convenient way is to contact your local hospital or gas supplier.

Does the conduction tubing need to be sterilized after each patient?

Any part of the tubing that is not corrugated can be sterilized. This can be done after each patient, but it is not necessary. Surface disinfection is adequate.

Is a written consent form necessary?

Certainly verbal consent must be obtained before each N2O/O2 procedure, and written consent is prudent practice. A sample written consent form has been provided in Appendix D.

What actions should the operator take if unsure about the appropriateness of N2O/O2 sedation because of the patient's mental status or prescribed medications?

Do not be afraid to consult with the patient's physician whenever you have questions about the appropriateness of sedation.

What actions should be taken if a leak is detected in a hose or reservoir bag during administration?

It is best to check for leaks before administration of N2O and O2; however, hoses or a reservoir bag should be replaced at any time a leak is detected.

Is a backup portable system necessary?

It is highly recommended to have a second tank of each gas immediately available should one be emptied in the middle of a procedure.

Can a patient with a head cold and stuffy nose use N2O/O2 sedation?

It is not recommended to use N2O/O2 sedation in this case because the patient will not be able to breathe well through his/her nose. The gas will not be able to get through the respiratory system easily, thus making good sedation unlikely.

Is it possible that a person could be a hyporesponder to N2O and O2 sedation at one appointment but then a hyperresponder at the next appointment?

It is possible, but not likely. However, if a patient was breathing through his/her mouth and intentionally trying not to be sedated, it is possible that more N2O would be necessary to achieve desirable results. As the patient relaxes and accepts the N2O and O2, it may be possible that less drug is needed for ideal sedation at a subsequent appointment.

Will a patient's minute volume change between appointments?

It is unlikely a patient's minute volume will change much as an adult unless a respiratory illness is present. The practitioner can easily reevaluate the appropriate minute volume with each administration.

What should I do if my patient's postoperative pulse rate is more than 10 beats per minute different than the preoperative value?

Keep administering 100% postoperative O2 and reevaluate the pulse rate in a few minutes. Remember, the patient is likely to be more relaxed at the end of the appointment than at the beginning so vital sign values should be lower.

How does N2O affect the lactating (nursing) mother?

N2O has no effect on breast milk.

What is the youngest age in which N2O/O2 sedation can be administered?

N2O/O2 sedation can be used for patients of any age.

Why is the machine that dispenses N2O/O2 such an important piece of emergency equipment?

N2O/O2 sedation machines allow for positive-pressure O2 to be delivered to the patient. This is the treatment for laryngospasm and for ensuring the lungs are well ventilated with O2. It also does not require the skill associated with the use of an Ambu bag.

What is the number one potential negative side effect?

Nausea and vomiting. This can occur with an inappropriate administration technique, inadequate monitoring, and/or if inappropriately high concentrations of N2O are used.

Will N2O show up in a drug screening test?

Nitrous oxide is not biotransformed by the liver. However, it is possible a small amount is excreted in the urine.

Can a patient be allergic to N2O?

No known documented true allergies to N2O exist at this time.

Will the N2O cylinder start a fire in the tank room of a dental office?

No, N2O is not flammable itself; however, in the presence of fire, N2O will support combustion and will explode.

Does N2O disintegrate in the cylinder over time?

No, N2O remains unchanged in the cylinder. It is required that cylinders must be inspected for integrity every 5 to 10 years.

Is it acceptable to leave the patient alone during N2O/O2 sedation?

No, a sedated patient should be monitored. A team member who is appropriately credentialed may monitor the patient in the brief absence of the operator.

Do you need to titrate the N2O to lower concentrations when you are finishing a procedure and preparing to administer 100% O2?

No, it is not necessary to slowly remove the N2O at the completion of the procedure. Terminate the N2O flow completely and begin the minimum 5 minutes of 100% postoperative oxygenation.

4. Is a pulse oximeter necessary for N2O/O2 sedation?

No, not if N2O is given in concentrations less than 50%; this is defined as minimal sedation. At amounts greater than 50%, the level of sedation is now defined as moderate sedation. It is recommended to monitor the patient with a pulse oximeter at this level of sedation.

Can an N2O tank accidentally get attached to the O2 side of a portable sedation unit?

No, not if the Pin Index Safety System is in place. The configuration of holes on the N2O tank stem valve will only fit the pin configuration on the N2O side of the yoke attachment.

Is N2O/O2 effective on patients with dental phobia?

No, patients with a true phobia will likely require additional assistance with a dental appointment, such as moderate or deep sedation.

Can I use N2O without O2?

No, the O2 molecule must be available for human metabolism. The use of N2O without O2 could result in death.

33. Do all people experience the same signs and symptoms during N2O/O2 sedation?

No, there are signs and symptoms common to many people, such as tingling or feeling light or heavy, but patients react individually to this drug. The goal for all patients is to become relaxed and comfortable.

Is there N2O in aerosol cans of computer duster?

No, there is a coolant in the can, but it is not N2O.

Is sickle cell anemia a contraindication to N2O/O2 use?

No. In fact, preventive measures for sickle cell crisis use 100% O2.

Is N2O/O2 sedation contraindicated for an individual with congenital birth defects?

No. N2O/O2 sedation is used for a variety of medically compromised patients. However, medical consultation is required.

Will the patient remember the appointment?

Patients who have N2O/O2 sedation often remark that time has passed more quickly than they realize. Appointments may seem shorter than they actually were. However, patients will remember what procedures were done and with whom they interacted.

Does it matter if the reservoir bag is not the same brand as my other hoses?

Reservoir bags are independent from conduction tubing and can vary between manufacturers on the machine. Different colors and sizes are available, and the type is operator preference.

Can "huffing" or "sniffing" a drug or chemical be dangerous the first time it is done, or does it require several times before negative consequences could occur?

Using an inhalant inappropriately could cause death on the very first time it is used. Inhaling 100% N2O is never recommended and highly discouraged.

Can you prescribe hydrocodone (Vicodin) following N2O/O2 sedation?

When the patient is completely recovered from N2O/O2 sedation, any postoperative medication will have no interaction with the previous N2O/O2 experience.

Is it okay to eat before receiving N2O and O2?

Yes, a light, non-fatty meal eaten no closer than 2 hours before the procedure is fine. It is best to avoid heavy meals.

Can N2O/O2 enhance difficult venipuncture?

Yes, a short course of N2O/O2 can enhance venous distention and visibility.

Are there any latex-free products available?

Yes, all currently manufactured products are latex-free.

Can the percent of drug delivered be recorded as the number that correlates with the floating ball rather than having to calculate the percentage?

Yes, as long as the total liters flow is also recorded. For example: 2 L/min of N2O delivered in a total of 7 L/min can be recorded as 2/5, allowing the percentage to be calculated as approximately 20% (2 ÷ 7 = 28.57). The numbers recorded in the patient's record must be the amount of N2O given divided by the total liters per minute delivered. However, it is recommended to record the percentage to avoid confusion.

Can I return to work immediately after I have used N2O and O2 for a medical/dental procedure?

Yes, as long as you feel like your normal self. Some people feel tired or very relaxed following sedation, especially if they were very anxious before a procedure. The standard of care is to administer a minimum of 5 minutes of postoperative O2 and some people need additional time. The person administering the drug is responsible for assessing the recovery of the patient and will recommend an escort when necessary.

Can I use oral premedication with nitrous oxide (N2O)/oxygen (O2)?

Yes, but there will be a synergistic effect between the N2O and other drugs. Therefore it is important to know the pharmacology of all the drugs involved. You are responsible for all the drugs you administer, and you must be prepared to rescue a patient from the next level of sedation beyond that which was intended. An oral sedative plus N2O and O2 places the individual in the category of moderate sedation, which requires additional monitoring.

Is it necessary to document the N2O/O2 sedation procedure in the chart?

Yes, for legal reasons it is required to document each N2O/O2 procedure. A sample of a sedation record is included in Chapter 13 and in Appendix G.

Can a rash around the nose indicate an allergy to the nosepiece if it was latex?

Yes, if the individual is latex sensitive or if the nasal hood was inappropriately disinfected and not sterilized.

Can patients go unconscious when N2O/O2 sedation is administered?

Yes, it is possible; however, N2O is not a potent anesthetic agent, so it will not be used as a sole drug to render someone unconscious. It can be used with other drugs for surgical procedures in which a person is unconscious. In an ambulatory setting, such as a dental office, it is not intended for the patient to be unconscious. Therefore vigilant monitoring and appropriate administration technique is required for patient safety.

Can a patient listen to music while being sedated with N2O and O2?

Yes, of course. Music is a welcome addition to N2O/O2 sedation because it often promotes relaxation.

Does insurance pay for N2O/O2 sedation?

Yes, some companies reimburse for this service, although others do not. In the United States, the American Dental Association reimbursement code is D9230

Is it possible that N2O will not work for some patients?

Yes, some people do not experience the sedative effects of N2O and would be considered a nonresponder. Other methods of pain and anxiety relief are available.

Is the high-volume evacuation mandatory when using N2O/O2 sedation?

Yes, the high-volume suction is an integral part of the scavenger system.

Will a patient with an endocrine condition, such as hypothyroidism or diabetes, be a good candidate for N2O/O2 sedation?

Yes, there are no contraindications to individuals with these conditions.

Can N2O be used with a laser present?

Yes, this is not a contraindication for its use.

Is it possible for the patient go to sleep during N2O/O2 sedation?

Yes. However, this does not occur when using the appropriate titration technique. The patient should not be allowed to become drowsy or somnolent.