N2O (DEN 155) - Ch 1/2- Complete

Discovery of Nitrous oxide (N2o) and oxygen(o2)

-Discovery happened 1771-1777

-nitrous oxide was discovered

-"good air" was also discovered now known as oxygen

Who inhaled pure N2O?

Who noted that pain was Diminished while using N2O?

When was N2O pursued to diminish pain?

What was the first clinical procedure when using N2O?

-Humphrey Davy inhaled pure N2O despite people thinking it would contribute to many diseases and deadly conditions.

-Davy noted diminished pain from using N2O while having inflammation of the gum.

-this diminished pain wasn't pursued for some time until the early 19th century

-The first clinical procedure using nitrous as an anesthetic agent was tooth extraction

who is the father of anesthesia

Horace Wells

Attempted to extract a tooth in front of peers to show that nitrous oxide worked, after completing several successful extractions

anesthesia

Defined as insensitivity to pain, especially as artificially induced by the administration of gases or the injection of drugs before surgical operations

Anesthesia was at first unpredictable

Nitrous oxide now produces a very predictable outcome for anesthesia

where there early forms of anesthesia, if so what were they?

Early forms of anesthesia include the following

 -chloroform

 -ether

 -alcohol

 -cocaine

when was lidocaine introduced?

Lidocaine was introduced in 1940

 minimal allergies

 diminished Nitrous oxide use

Resurgence of nitrous oxide

Gardner Colton encouraged dentists to use pure N20 - he had 193,000 documented cases with no fatalities

Dr. Edmund Andrews suggested that the blood isn't appropriately oxygenated with 100% nitrous oxide

Now the ADA standard is ensured that 30% of oxygen is delivered at all times

Not just used for pain control but also to reduce anxiety

Guidelines for best practice

The dental profession was the first to adopt the use of nitrous oxide sedation.

The safety of the use of nitrous is well tested and it has withstood the test of time.

It's effects are quickly reversed.

Few side effects as long as operator is using updated equipment and appropriate technique

1. It is difficult to predict how a patient will react to sedation.

2. There are several levels of sedation

Minimal sedation

Moderate sedation

Deep sedation

General anesthesia

The intent of nitrous oxide is to:

control pain and anxiety

be quickly and easily reversed

make the patient comfortable

Levels of sedation

Minimal Sedation (anxiolysis)

• Drug induced state during which patients respond normally to verbal commands

• Airway reflexes, breathing and cardiovascular function are unaffected

• Nitrous less than 50% concentration

Moderate Sedation

• Drug induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation

• Airway requires no intervention, and cardiovascular function is maintained

• Nitrous more than 50% concentration, or given less than 50% but with another sedative

Deep Sedation

Drug induced depression of consciousness during which patients cannot be easily aroused but respond after painful stimulation

May require assistance in maintaining an airway, and cardiovascular function is maintained

Think IV sedation at a dental office or oral surgeon

General anesthesia

Drug induced loss of consciousness during which patients are not arousable even by painful stimulation

Often require assistance in maintaining an airway, and cardiovascular may be impaired.

Not typical to reach this with nitrous oxide

(Think joint replacement)

Current Practice Guidelines

Created in 2002 for those delivering N2O but not specialists in anesthesiology

 ie: dentists, podiatrists, physicians

Most current information was published in 2018

Separate guidelines for pediatric patients was written in 2016 with input from the following agencies

 ASA (American Society of Anesthesiologists)

 AAP (American Academy of Pediatrics)

 AAPD (American Academy of Pediatric Dentistry)