External Phone Log
Nitrous Oxide Program
By Judith, a patient mom
Daniel is our 3 year old who was diagnosed by the doctors as having severe Hemophilia B and described by the nurses as having a “strong personality.” To date, he hasn’t had any joint bleeds or spontaneous bleeds so we haven’t gone the route of prophylaxis. This means that when he does have a bleed, we either head down to the clinic or just as often (because he likes to bleed on nights, weekends and holidays) to the Children’s Emergency Room in St. Paul. That is okay with him - he isn’t picky; the clinic has really cool toys and the ER has Stephanie who will play endless pretend games involving dinosaurs and tigers!
Several months ago, we went to the Emergency Room. My 15 year-old daughter Kelsey was with me. Because this was going to be her first time seeing Daniel get factor, I had spent time preparing her for how Daniel was going to react and by letting her know that he would probably get very upset.
Once we got back into a room, we were offered the option of giving Daniel some nitrous oxide. My own experience with nitrous oxide at the dentist’s office made me think that this might be a good idea because it would make him more relaxed. The nurse proceeded to go through a checklist with me to make sure that nitrous was a good option for him. Daniel was able to choose a “flavor” which was rubbed inside the mask (the elephant mask!) and he then proceeded to take some deep breaths. It was amazing!! We made it through the entire infusion without a single tear (although not without hearing various animal sounds and a rendition of “Rudolph the Red Nose Reindeer”). Kelsey was probably thinking that
I had completely exaggerated the trauma of past visits! I hadn’t – this was by far our best experience with getting an infusion as evidenced by the fact that it took only three staff to administer the factor versus five!
Since that first experience, we have had nitrous oxide in the clinic and just last week, in the ER again. Each time, the nitrous oxide has helped to make the process easier on all of us.
As Daniel continues to grow and mature, he’ll be able to make his own decisions on how he gets his factor. For now, the nitrous oxide makes things go more smoothly. I’m glad that this has become an option in both the ER and in the clinic.
Nitrous Oxide Program Overview
Children’s Hospitals and Clinics of Minnesota pioneered the development of a nurse-administered nitrous oxide sedation program designed to provide greater comfort for pediatric patients as they undergo stressful procedures. The following information highlights the unique components of the program, and offers tools and resources based on the success of Children’s program.
Why nitrous oxide?
Nitrous oxide (N2O) is a mild sedative anxiolytic, with analgesic and amnestic properties. Dentists have taken advantage of these properties since the 1840s. Although nitrous oxide sedation has been practiced in health care settings across Europe and Australia for years, studies on the use of nitrous oxide in pediatric patients in the United States began to appear in journals approximately 25 years ago (Griffen, G.C., Campbell, V.D., Jones, R. “Nitrous oxide-oxygen sedation for minor surgery – experience in a pediatric setting” JAMA 1981, Vol. 245:2411-3). More recent reports and studies conducted at Children’s Hospitals and Clinics of Minnesota confirm the safety and efficacy of nitrous oxide for pediatric patients.
Nitrous oxide produces “conscious sedation” with the patient remaining awake but calm throughout its administration. When children are relaxed, they are able to follow verbal instructions. Despite their “awake” state, up to 80 percent of children are unable to recall a painful procedure when nitrous oxide is used for sedation/analgesia.
The relief provided by nitrous oxide administration is not accompanied by the side effects associated with other sedatives, including combativeness, which can occur in patients coming out of sedation. Additionally, when compared to other commonly used sedation drugs, nitrous oxide is shorter acting. Many children can walk out of their hospital visit without assistance after a brief recovery, and some older patients can actually return to activities, such as school, after a medical procedure.
In the first four years of the program, Children’s studied more than 4,800 patients for side effects and outcomes. The study revealed mild side effects that were well tolerated. Just over five percent of children experienced nausea or vomiting, which resolved quickly when the nitrous was discontinued.
Lecture Presentation Videos
The following four lecture presentations are also available on the CD that accompanies the toolkit. They are listed in suggested viewing order. You may also access these videos on the Children's Video Education page.
You Want to Do What? Leaping the Hurdles to an Effective Nitrous Oxide Program
Judy Zier, MD; Mary Kay Farrell, RN, C
Play Video #1 (80:00)
Nitrous Sedation Experience in the Emergency Department
Jeffrey Louie, MD
Play Video #2 (45:00)