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Nitrous Oxide Program
The nitrous oxide sedation program at Children's of Minnesota was developed using a model of physician-nurse collaboration supported by nurse directors, anesthesia, critical care, radiology, and nurse pioneers to improve care for pediatric patients. Since its inception, the program has experienced widespread appeal among patients, families, and practitioners.
The program's success includes a high level of patient, family, and staff satisfaction, as well as increased efficiency in targeted patient care areas. The success of the program has generated interest among our colleagues in the community and across the nation. In the spirit of improving the health care experience for all children, we are proud to share the following tools and resources that may be helpful in considering the development of a nitrous oxide sedation program.
Frequently Asked Questions
What is nitrous oxide?
Nitrous oxide, a blend of two gases, nitrous oxide and oxygen, is a mild, fast-acting, safe sedative. The calming effect of nitrous oxide reduces anxiety and pain, sometimes causing patients to forget the procedure.
What are the side effects?
Children’s research on more than 4,800 patients from 2004 to 2008 showed that nitrous oxide has few side effects. Just over five percent of patients sedated with nitrous oxide experienced minor side effects. The most common were vomiting (2.5%) or nausea (2%). In comparison, up to 12 percent of patients have been reported to experience side effects from the oral sedative previously used for many of these procedures.
Before nitrous oxide, what did children receive as a sedative?
Some patients received the sedative Versed, which stayed in their systems for six hours and sometimes caused belligerent and combative behavior. Children who received Versed could not return to school after their procedure. Given the side effects, many parents decided against using Versed. Another sedative, Propofol, requires an IV for administration, causing additional distress to the patient.
How long do most children receive nitrous oxide during a test or procedure?
The average length of use at Children’s is 11 minutes. A nurse monitors the child at all times as they receive nitrous oxide. For longer tests or procedures, nurses adjust the amount of sedation based on the length of the procedure and the child’s need for pain management.
How safe is nitrous oxide?
It’s extremely safe. Among medical gases, nitrous oxide is considered to be very mild. Children’s equipment to administer nitrous oxide is fail-safe, so an overdose is impossible.
What is needed to properly maintain equipment?
Equipment should be inspected prior to clinical use. Ongoing maintenance (e.g., quarterly leak checks) can be coordinated by the hospital biomedical department. Flowmeter checks are routinely performed per manufacturer guidelines. Most recommend monthly checks (e.g., non-rebreathing valve check, emergency air valve check). Appropriate function of the fail-safe valve is confirmed with each use. Equipment is cleaned per infection control departmental guidelines.
Are there exposure risks to staff?
Risk to health care professionals administering nitrous oxide remains open for debate. Most data on adverse effects of occupational exposure were collected before scavenging systems were developed to decrease environmental nitrous oxide during administration. Good administration technique, proper equipment maintenance and appropriate use of the scavenging system will minimize staff occupational exposure. The hospital safety officer can ensure that regulatory standards from the National Institute of Occupational Safety and Health (NIOSH) and/or the American Conference of Governmental Industrial Hygienists (ACGIH) are met.
Why has nitrous oxide been available only in dentist offices, not medical settings?
Traditionally, dentists—not physicians—have been trained in the use of this gas. Although the first article on nitrous oxide use for general pediatric procedures appeared in the Journal of the American Medical Association 25 years ago, its use has remained mostly in dentistry. There are a few emergency departments that use nitrous, and the numbers continue to grow.
Is nitrous oxide used for medical care outside the U.S.?
Yes, it’s used in Europe, Israel, Australia, and New Zealand.
Contact Us or Order a Free Toolkit
For questions, or to order a Nitrous Oxide toolkit, please call or e-mail Lynn Eidahl, MA, RN, at (612) 813-6172.
There is no charge for the toolkit; it is free. The toolkit includes the brochure and CD. The CD contains the four lecture presenations linked to from this page. The videos are also available on the Children's Video Education page.
3 Tesla MRI System
An MRI, or magnetic resonance imaging, system allows physicians to watch blood and electrical impulses travel through the brain. The 3 Tesla MRI System, available at Children's through a partnership with Abbott Northwestern Hospital, is twice as powerful and faster than standard MRI machines. The system provides detailed views of anatomy as well as metabolic functioning. For example, prior to brain tumor surgery, 3 Tesla MRI images allow the neurosurgery team to better map the tumor and determine its relationship with areas of the brain involved in important functions such as speech and movement. After surgery or tumor treatment, 3 Tesla MRI images provide the team with a dynamic portrait of the metabolic and physical changes happening in the tumor.