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.
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.
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.
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.
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.
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.
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.
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.
Yes, it’s used in Europe, Israel, Australia, and New Zealand.