Nitrous Oxide and Oxygen Sedation
An acceptable amount of nitrous oxide to begin the titration technique for an adult requiring 7L/min would be _______ on a machine with floating balls in glass tubes
1 to 1 1/12 liters
Oxygen makes up approximately _____% of the atmosphere.
21
The initial flow of N2O/O2 in liters per minute (L/min) for child between 3 and 5 years of age should be set to
3 to 5
The following are disadvantages characteristics of which route of pharmacologic administration: Inablility to titrate dose unreliable absorption affected by gastric contents prolonged duration significant latent period potiential patient noncomplience, especially with children
Oral
The color code for oxygen in the US is green; however, the universal commonly associated with oxygen in many other parts of the world is
White
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
a catastrophic explosion
The drug most commonly delivered concomitantly with N2O/O2 in the dental setting is
a local anesthetic
Appropriate procedure to follow when the patient indicates he/she is still dizzy following the initial 5 minutes of postoperative 100% oxygen
administer an additional 5 minutes of 100% oxygen and reassess
N2O/O2 sedation can be useful whe taking oral radiographs because it
depresses the oral gag reflex
Term used to define the decrease in blood oxygen saturation caused by the rapid exit of nitrous oxide upon its discontinuation
diffusion hypoxia
The least frequently observed sign of N2O/O2 sedation in children is
laughter
A major source of trace nitrous oxide that contaminates the ambient air in a dental office is from
the patient talking
It is recommended to periodically calibrate and perform routine maitenance on the flowmeter. Manufacturers' recommedations may vary bu a typical timeframe is every ____ years.
2
A pulse rate of 95 beats per minute for a 6 year-old child would be considered
normal
The bronchus with minimal divergence from the trachea and thereby likely to receive a foreign body is on the patient's
right
A full cylinder of nitrous oxide is likely to be approximately ____% liquid and ____% gas.
95, 5
The pulde oximeter uses light wavelengths to measure the amount of oxygen saturation of arterial blood. Value considered normal for a healthly individual
98
The individual who has posthumously been recognized as the "Father of Anesthesia" because of his clinical use of nitrous oxide is
Horace Wells
The individual credited for the discovery of nitrous oxide was
Joseph Priestly
Three items associated with a central gas supply N2O/O2 sedation system
Manifold, Large cylinders (G, H), Regulator
Signs of appropriate level of sedation using N2O/O2
Pt is comfortably warm Pt smiles easily Pt indicates tingling in extermities NOT appropriate: pt is unable to keep mouth open
Research studies claim chronic exposure to nitrous oxide can inhibit whih vitamin B12 dependent enzyme
methionine synthase
The number of deaths associated with N2O/O2 sedation in a dental office as the sole sedative agent and using appropriate equipment and technique is
none
N2O/O2 has a significant negative impact on what body systems
none of this listed: hepatic, endocrine, genitourinary, renal
The safety device that prevents inadvertent attachment of the N2O cylinder to the O2 yoke on a portable unit is called
pin index safety system
Nitrous oxide is used in the racing industry to
enhance engine performance
Conducting tube connects the_____ to the ______ on the N2O/O2 sedation machine
flowmeter,, nasal hood
Nitrous oxide is _______ than air.
heavier
A patient who does not show any signs or symptoms during the administration of N2O/O2 sedation is considered to be
hyporesponsive
The concept of individual biovariability when administering drugs is based on the premise that
individuals may not react similarly to the same drug on different days
Inadequate sedation or falure is more frequently reported when N2O/O2 is administered in patients with
intellectual disability
The definition of "direct supervision" found in a states medical or dental practice act regarding the administration of N2O/O2 sedation by an auxiliary would indicate the ________ presence of a physician or dentist.
mandatory
Current "best practice guidelines" for N2O/O2 sedation use in the US are recommended by each of the following organizations except one. Which is the exception?
FDA
The individual responsible for lecturing about the virtues of nitrous oxide and sproting it was entertainment in town halls was
Gardner Quincy Colton
Minute ventilation is approximated by multiplying _____ by ____
tidal volume, respiration rate
Administering nitrous oxide and oxgen to a patient who requests it "because it makes me feel like I'm high and I like that" would be considered
unethical
Relevant to pediatric sedation Exception?
unobstructed upper airway medications taken pt's acceptance of the nasal mask exeption: pt's weight
A sign with respect to hearing that would indicate an appropriate level of sedation
voices may seem further away
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
The rapid onset of action with N2O/O2 sedation is advantageous. Effects are usually first seen within______ minutes.
5
Relative contraindications to the use of N2O/O2 sedation Exception?
Patient with psychotic illness taking several medications Patient who does not have the mental capacity to understand the procedure Operator who cannot communicate with the patient bc of a language barrier Exception: Patient has undiagnosed anorexia
Relative contraindications of N2O/O2 Exception?
Severely claustrophobic patients Current upper respiratory tract infection First trimester of pregnancy Alcohol intoxication or drug use Exception: hypersensitive gag reflux
Monitoring patient's signs and symptoms throughout the entire sedation experience is vital to success. What is the appropriate sequence of events leading to a relaxed and comfortable patient?
Slight tingling in extremities to vasodilation in face and neck
Best describe the amnestic effect associated with N2O/O2 sedation on a paitent
The patient believes less time passed than was actually spent at the appointment
Signs that an individual may be anxious Exception?
Tight grip on chair or "white knuckles" Beads of perspiration Cool, clammy skin Exception: Tendency to fall asleep
Preprocedural fasting is mandated requirement for patients undergoing nitrous oxide/oxygen sedation by the ADA and the AAP/AAPD in an ambulatory setting BECAUSE a frequent side effect of nitrous oxide drug is vomiting
NEITHER the statement NOR the reason is correct
A pulse oximeter is a device that may be used during N2O/O2 sedation to assess the level of
O2 saturation of arterial blood
Nitrous oxide is not used as a sole anesthetic agent for surgery in the operating room at a hospital because Exception?
it is the least potent (weakest) of all inhalation it has a MAC value of 104% to 105% profound surgical anesthesia is unattainable unless it is used under hyperbaric conditions Exception: it is much more expensive than halothane or sevoflurane, which are agents commonly used
The drug-induced state during which patients respond normally to verbal commands and have possible cognitive and coordination impairment, but ventilatory and cardiovascular functions ar unaffected is
minimal sedation
In addition to dentistry, N2O/O2 sedation has had a long-standing history of us in
obesterics
Scavenging devices recommened to minimized N2O concentrations in a dental operatory include Exception?
adequate suction systems that vent outside use of scavenging mask/nasal hood regular inspection of equipment for leakage exception: recirculating exhaust ventilation system
Typical product used as an inhalant
airplane glue paint thinner shoe polish exception: butter
Accomplished during the titration technique for N2O/O2 sedation Exception?
allows for individual biovariability minimized oversedation potential delivers only the amount of drug necessary uncover idiosyncratic reactions early Exception: standardizes all patient reactions
The raw ingredient_______ is heated to create nitrous oxide and water plus a few impurities
ammonium nitrate
Which systems does nitrous oxide have the greatest impact
central nervous system
Procedure to follow when a pt suddenly feels uncomfortable in any way during N2O/O2 sedation
decrease the % of nitrous oxide being delivered to the pt
Indication of inadequate recovery of a patient following nitrous oxide/oxygen sedation
patient indicates a "groggy, lethargic" feeling
The primary objective of physiologic pain is to
provide protection for the body against potential damage
Potential indication within the emvergency department (ED) Exception?
radiograph acquisition laceration repair wound debridement exception: angioplasty
Nitrous oxide is often used during induction of general anesthesia because it promotes the rapid uptake of a more potent general anesthesia agent. This property is called
the second-gas effect
The first clinical procedure using nitrous oxide as the anesthetic agent was
tooth extraction
The legal parameters of N2O/O2 sedation administration are found in a state's codified law. Legal parameters of N2O/O2 sedation administration are the same for every state in the US.
true; false
Symptoms of neuropathy commonly seen in persons who chronically abuse N2O include
unsteady gait, clumsiness tingling and /or paresthesia in extremities impaired psychomotor function and dexterity exception: insomnia, acute sensitivity, hyperacitivity
Informed consent for N2O/O2 sedation should be obtained each time it is administered. It is recommended that ______ consent be acquired
written
Preprocedural instructions must be given to the patient before N2O/O2 sedation. Each of the following would be appropriate except
Appropriate: Expectations of sedation outcomes, signs and symptoms of appropriate sedation Exception: Specific amount of drug to be delivered
Signs of patient oversedation when using N2O/O2 sedation
Dizziness Nausea Slurred speech Floating sensation NOT a sign: Slow blink rate
Largest impact on adverse events
Durtation of nitrous oxide exposure
Blood pressure that value classified as prehypertension
120/80 mm Hg
The concentration of nitrous oxide inhaled from a "whippet" and a balloon is
100%
The oxygen fail-safe device that is required on all N2O/O2 sedation machines ensures that
100% N2O cannot be delivered
A patient will not cognitively recover from 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 a family member following N2O/O2 sedations.
Both statements are false
The maximum exposure limit of 500 ppm N2O for dental personnel set by NIOSH in 1977 is still in effect today. This Occupational Exposure Limit for the United States was based on sound biologic data from valid, reliable research.
Both statements are false
Nitrous oxide gas by itself is not flammable. If nitrous oxide comes into contact with a flame, it will explode.
Both statements are true
The oxygen in the N2O molecule that is not available for use by the body because N2O does not break down in the body.
Both the statement and the reason are correct and related
A scavenging mask/nasal hood prevents waste gas from being eliminated through the patient's mouth.
False
A 52 year old patient with hypertension being controlled by daily medication would be classified as ASA
II
As you begin N2O/O2 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 oxygen flow to the patient
All are true except? Always titrate the amount of nitrous oxide being used Begin the procedure with 100% O2 when establishing minute volume Oxygenate the patient for a minimum of 5 minutes following termination of N2O Squeeze out the mixture of gases in the reservoir bag before postoxygenation
Squeeze out mixture of gases...
A tingling sensation in the extremities is a sighn seen with all patients using N2O/O2 sedation. All patients appropriately using N2O/O2 sedation will have intact cough and gag reflexes
The first statement is false; the second statement is true
Oxygen gas is pressurized in the cylinder at 750 psi. The oxygen gauge will constently show an accurate amount of gas remaining in the cylinder.
The first statement is false; the second statement is true
Health disciplines other than dentistry using N2O/O2 sedation are likely to use a full face mask for gas delivery. N2O/O2 sedation used in the ambulance is likely to be a 50:50% system with demand flow
both statements are true
Considered an anxiolytic effect of N2O/O2 sedation Exception?
calm, tolerant, relaxed, comfortable Exception: Stressed
An absolute contraindication of N2O/O2 sedation would be a patient with
cancer therapy using bleomycin sulfate
Factors that can influence an individual's response to pain Exception?
current stress level, illness/infection presence, cultural expectations Exception: eye color
A common area of spasm evidenced by significant cough and gag reflex occurs at the
larynx
Reducing pressure fro the cylinder to an appropriate level for patient inhalation is accoplished by
regulator
A drug that diffeses immediately into the blood and is rapidly distributed across the body is considered
relatively insoluble
True regarding inhaling chemicals Exception?
the chimicals are foundin a vaariety of hosehold products the "high" is short-lived and quickly obtained products typically inhaled are relatively inexpensive exception: all chemical inhalants are illegal to sell to minors
