Nitrous

Oxide
Sedation
in Dentistry
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Introduction to Nitrous Oxide Sedation

• Nitrous oxide is a colorless and odorless gas with a faint,

sweet smell

• It is an effective analgesic agent which depress the central

nervous system (CNS) and in some cases, euphoria with little
effect on the respiratory system.
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Types of Fears in Dentistry

• Fear of Pain
• Fear of the “Drill”-due to slipping, sense of cutting, noise,
smell etc.
• Fear of the ‘Needle’ – Fear of pain injection, tissue injury,
numbness, deep penetration
• Fear of surgery – threat to body image, pain especially in OMS
• Fear of Loss of the Teeth
• Fear of the Unknown
• Fear of Helplessness and Dependency
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Why Nitrous oxide?

• Mild sedation and is safe
• No injection required as with IV sedation
• Nitrous oxide is absorbed rapidly, allowing for both rapid onset and
recovery time (two to three minutes).
• Prevent gag reflex
• It permits titration; depth of sedation can be varied throughout procedure
with rapid on clinical effects
• It exhibits a superior safety profile with no recorded fatalities or cases of
serious morbidity when used within recommended concentrations
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What are the purposes of IHS?

• Reduce or eliminate anxiety.
• Reduce movement and reaction to dental treatment.
• Enhance communication and patient cooperation.
• Raise the pain reaction threshold.
• Increase tolerance for longer appointments.
• Aid in treatment of the mentally/physically disabled or
medically compromised patient.
• Potentiate the effect of sedatives (patient for whom profound
local anesthesia cannot be obtained)
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What to check before N20 administration?

• Allergies and previous allergic or adverse drug reactions.

• Current medications including dose, time, route, and site of administration.
• Diseases, disorders, or physical abnormalities
• Pregnancy status.
• Previous hospitalization to include the date and purpose.
• Recent illnesses (e.g., cold or congestion) that may compromise the airway.
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Contraindications

• Patient unable to breathe through the nose, eg : flu

• Chronic obstructive pulmonary diseases
• Current upper respiratory tract infections.
• Recent middle ear disturbance/surgery
• Severe emotional disturbances or drug-related dependencies.
• First trimester of pregnancy
• Claustrophobic patient
• Eye surgery within two weeks eg : Retina attachment, Intraocular surgery
 Accutron Nitrous Oxide
Sedation
Accutron™ is a leading manufacturer of innovative nitrous
oxide/oxygen sedation equipment and accessories made in USA.
For over 45 years the company’s single focus has been to design
and manufacture high quality sedation products that assist dental
practitioners in relaxing their patients and making their dental
visit a comfortable experience.
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Why Accutron?
• A complete line of nitrous oxide equipment and accessories,
and its compatible emergency oxygen equipment.
• The systems are built around three basic principles : efficacy,
safety and asepsis.
• Designed to integrate in a wide variety of dental office
environments
• Accutron is the only manufacturer to offer a broad selection of
brightly colored, scented, single-use nasal masks.
• Latex-free materials
 12

89,526,124$
That’s a lot of money

185,244 users
And a lot of users

100%
Total success!
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Accutron Equipment

• 4 compressed Aluminium gas cylinders

( 2 Oxygen and 2 Nitrous Oxide gas)
• Pressure gauge
• Pressure regulators
• Flowmeters
• Reservoir bag (T-Bag)
• Tubing
• Scavenging circuits
• Nasal mask
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Accutron Features

• Unique Pin Index system

• Color coding on the gas tank
• Oxygen-fail safe
• Emergency air inlet
• Oxygen flush button
• Reservoir bag
• Clear-transparent outer layer of mask
• Print button function
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Techniques of
Administration

21
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Consent
Form
Records include :
• Dietary precautions
• Indication for use of nitrous
oxide/oxygen inhalation
• Dosage (% of Nitrous oxide and Oxygen
• Flow rate
• Duration of the procedure
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“
Patient preparation

Fasting is not required for patients undergoing

nitrous oxide analgesia.

However, may recommend that only a light

meal be consumed in the two hours prior to the
administration of nitrous oxide.

”
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Techniques of Administration
1. Select a proper nasal mask
2. Switch on the sedation unit (Digital)
3. Open both tank of Oxygen and Nitrous Oxide gas
4. Start with a flow rate of 5-6 L/min of Oxygen for 1-2 minute
5. Observe the reservoir bag. Reservoir bag should be 2/3 full
6. Introduce nitrous oxide at 10% intervals.
7. Observe patient’s breathing at this point, check with Pulse
Oximeter
8. Patient should appear calm and relaxed while eyes will
remain open
9. After finish the treatment, decrease the N20 percentage
gradually
10. Give 100 % oxygen by adjusting manually or use Oxygen
flush button for rapid flow 100% of concentrated Oxygen
approximately 3 minutes before removing the nasal mask
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Techniques of Administration

Fast Induction Techniques

1. Indicated for mild to moderate

anxious patients
2. Involve 50% nitrous oxide
directly to the patient without
any titration steps
3. Give 50% nitrous, ask patient
to take two deep breaths and
adjust to their normal level
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Signs and Symptoms

Early to ideal sedation :

• Feeling of warmth
• Light headedness or dizziness
• Tingling or numbness of extremities
• Feeling of light or heavy extremities
• Euphoria
• Feeling of vibration
• Relaxation of skeletal muscle
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Signs and Symptoms

Heavy sedation or Oversedated

• Hearing of distant sounds more acute
• Laughing or crying
• Visual disturbance or room spins
• Sleepiness
• Dreaming
• Sweating
• Nausea or vomiting
• Loss of consciousness
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Best practice when using N20

1. Check test connections for leaks using a soap solution each time a gas tank is changed
2. Inspect all of the system components; reservoir bag, tubings, masks, connectors for wear and tear, cracks, holes
3. Start nitrous oxide gas flow AFTER nasal mask is securely placed over the patient’s nose
4. Turn off Nitrous Oxide gas flow BEFORE turning off Oxygen flow to the patient
5. The mask need to be properly fitted to each patient
6. Check that the reservoir bag does not over or underinflate while the patient is breathing oxygen, before the nitrous is administered.
7. Keep the patient’s talking and mouth breathing to a minimum to achieve good sedation
8. Scavenging vacuum should not be so strong as to prevent adequate ventilation of the lungs with nitrous oxide
9. Typical patient requires from 30 to 40 percent nitrous oxide to achieve ideal sedation
10. Maintain visual monitoring : patient’s responsiveness, color, and respiratory rate and rhythm.
11. Spoken responses provide an indication that the patient is breathing
12. Practice together with traditional behavior techniques during the treatment as the effects of nitrous oxide largely dependent on physical
reassurance
13. Deliver 100% oxygen to the patient for 3-5 minutes before removing the mask after the procedure. This will purge the system of any residual
nitrous oxide by clearing the drug and avoid diffusion hypoxia
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Facilities and equipment

• An emergency cart (kit) must be readily accessible.

• Emergency equipment must be able to accommodate children of all ages and sizes.
• It should include equipment to resuscitate a nonbreathing, unconscious patient and
provide continuous support until trained emergency personnel arrive
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Gas Tank Color Coding

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Gas Tank Pressure Gauge Indicator

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“
Whenever possible, appropriate medical specialists should
be consulted before administering analgesic agents to
patients with significant underlying medical conditions
(e.g., severe obstructive pulmonary disease, congestive
heart failure, sickle cell disease, acute otitis media, acute
severe head injury).
In addition, consultation with the prenatal medical
provider should pre-cede use of nitrous oxide/oxygen
analgesia during pregnancy

”
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Thanks!
😉