Module 3 - Inhalation Sedation with Nitrous Oxide

Nitrous Oxide documentation MUST include what? other things it SHOULD include

1) Informed consent obtained and documented in chart

2) Percentage of N2O administered

3) Length of time the patient was sedated

4) Flow rate of gases during administration

1) indication for use

2) patient response and tolerance

Example of good NO documentation

Ideal NO sedation produces _____ and ____ effects, has a rapid onset of ___-___ minutes, has a ___ safety margin, a _____ recovery time, and no _____ effect

analgesic; anxiolytic; 2-5; quick; hangover

NO has a ____ solubility in blood, is excreted _____ through the lungs, can induce unconsciousness at concentrations above _____%, has no effect on ____, has no or slight increase on ____, and crosses the ____ and _____

low; unchanged; 70; HR, BP, BBB; placenta

Indications for NO sedation

1 - pts with anxiety

2 - pts with a tendency to faint

3 - pts with a strong gag reflex

4 - medically compromised pts

5 - long procedures

6 - pts with inadequate LA

what is an absolute contraindication

administration of the drug increases the possibility of a life threatening situation

what is a relative contraindication

administration is preferably avoided due to possible adverse reactions

5 absolute contraindications of NO

1) Nasal Obstruction

2) Vit B12 Deficiency (can render B12 inactive)

3) Alcoholic / Recovering Addict

4) Uncommunicative (disability or language barrier)

5) Patient Refusal

Some relative contraindications of NO sedation

1) Middle ear infection

2) Balance disorder

3) Susceptibility to Motion Sickness

4) Claustrophobia

5) Pulmonary Diseases (med consult)

6) Immunocompromised (med consult)

7) Pregnancy (med consult)

8) Psychiatric Disorders/Bipolar (med consult)

9) Marijuana or Hallucinogenic Drug Use

some side effects of NO sedation

4 possible effects of long term exposure to NO

- bone marrow suppression

- reproductive system disturbances

- neurological deficits

- possible hepatotoxicity

On NO equipment, oxygen is ____, NO is _____. the ____ ____ button fills reservoir bag with O2 that can be used if the pt is ____ ____.

green; blue; oxygen flash button; over sedated

describe the oxygen fail safe mechanism

O2 flow maintained at 30% minimum, N2O at 70% maximum, the machine shuts off if O2 flow stops. this mechanism is required by law

O2 cylinder contains only gas, so gauge reflects ____ ____

actual contents

N2O in compressed gas cylinders is in both _____ and _____ states, filled to 90-95% capacity with liquid, gas layer above that liquid. Because of liquid, gauge will show full (750 psig) as long as _____ remains. Gas layer above liquid is _____ psig, as gas exits cylinder liquid vaporizes to replace it at same 750 psig. Once all liquid is gone and only gas remains, pressure gauge will fall in relation to remaining ____

liquid; gaseous; liquid; 750; gas

purpose of Pin Index safety system

cannot inadvertently reverse tanks

purpose of emergency air inlet

allows atmospheric air in if flow of gases stops

Scavenging Hood

in portable N2O tanks, compressed gasses are attached to the unit at the ____ _____

yoke assembly

The nasal hood and tubing are ____ use and _____. The sizer masks are ______-able

single; disposable; autoclave

Label the image (disregard 5, ours no longer have these in the clinic)

1 - O2 Flush button

2 - Master control (on/off)

3 - Control knobs forN2O / O2

4 - Flowmeters

6 - Pressure gauge

7 - Yoke assembly

8 - N2O pressure hose

9 - O2 pressure hose

10 - N2O tank ON-OFFvalve

11 - O2 tank ON-OFF valve

12 - one-way valve(to patient)

Describe NO administration