clinic procedures sedation record & nitrous oxide unit

what should you always record at each visit?

Blood pressure, pulse, and respiration

ASA means

American society of anesthesiologists

ASA I

Normal healthy patient

ASA II

Patient with mild systemic disease

ASA III

Patient with severe systemic disease

ASA IV

Patient with severe systemic disease that is a constant threat to life

ASA V

Moribund patient who is not expected to survive without an operation

ASA VI

Declared brain-dead patient whose organs are being donated

ASA class “E”

Patient requires emergency procedure

informed consent

Required with each procedure

• Patients/parents must understand the purpose of the procedure

• How it will be accomplished, and what to expect

• The benefits of this type of sedation

• The risks associated with using/not using this sedation

• Alternative viable options must also be offered

function of the respiratory system

Exchange O2 and CO2 across pulmonary/capillary membranes

levels of consciousness monitored by the patient’s…

response to verbal commands

Monitoring ventilation can be accomplished by

observation or auscultation

3 purposes of the reservoir bag

• supplemental supply of O2 for pt

• method of monitoring respiration

• emergency method of providing positive pressure O2

Professionals who use N2O/O2 sedation and/or local anesthesia must be:

• Certified in BSL for healthcare providers

• Cardiopulmonary resuscitation (CPR)

• Automated external defibrillator (AED)

• Management of airway obstruction for adults, children, and infants

what’s in an emergency kit?

• AED

• Antagonist medications

• Positive-pressure ventilation system.

• Adequate suction to clear an airway

• Advanced airway equipment, and

nitrous oxide storage

blue cylinder - nitrous oxide

green cylinder - oxygen

a full nitrous oxide cylinder

95% liquid & 5% vapor

• pressure gauge of 750 psi at 75 degrees F

• pressure doesn’t decrease until about 20% nitrous oxide

full O2 cylinder

2,200 psi

• pressure gauge is accurate

• at 0, there’s about 50 left

conduction tubing

Gas is delivered through tubing or hose stemming from the unit and attaching to the

breathing apparatus

breathing apparatus

• Gas may be delivered to the patient through a nasal hood or a full-face mask

• Nasal hood is designed to fit snugly over the patient’s nose

scavenging system

Helps to eliminate excess gas that is exhaled by the patient limiting the clinician’s exposure to exhaled N2O/O2

**what does nitrous oxide replace in the blood?

nitrogen

equipment safety

• all units deliver a minimum of 30% oxygen

• failsafe

titration

Administering a drug in incremental amounts until a desired endpoint is reached

• ex. nitrous oxide

N2O/O2 PROCEDURE

1. Open (crack) the tanks open flowmeter

2. Attach scavenger system to high-speed suction and turn on

3. Attach breathing apparatus (nasal hood)

4. Turn on 100% O2 to 6 liters (if bag) or 4 liters (no bag) for at least 2 minutes

5. Push O2 flush if the reservoir bag isn’t inflating

6. Place the nasal hood on the patient

7. Check the reservoir bag

N2O/O2 ADMINISTRATION

1. Titrate N2O 5% every 2 minutes until 10% N2O is in the reservoir bag

2. Perform planned procedure

3. Terminate N20 from flowmeter

4. Administer 100% O2 for 5 minutes prior to discharge

5. Begin PO vital signs 2 minutes into the 5 minutes 100% O2 postoperatively

6. Ensure recovery and dismiss patient

7. Turn off tanks

8. Remove scavenger system

9. Complete sedation record

10. Disinfect sedation equipment

nitrous oxide recovery

• same time as induction

• vital signs stable

sedation record

• preoperative & postoperative vital signs

• tidal volume

• peak %

• duration of drug administered

• info of recovery

• # of minutes of postoperative 100% oxygen

• any pertinent comments made by patient

ideal signs for a patient under nitrous oxide

▪ Comfortable and relaxed

▪ Tingling in extremities and/or mouth

▪ Acknowledges reduced fear/ anxiety

▪ Aware of surroundings

▪ Eyes become less active and glazed

▪ Will respond to verbal commands

ideal experiences for a patient under nitrous oxide

▪ Heaviness in legs and arms

▪ Body warmth

▪ Light feeling

▪ Vasodilation in face and neck

▪ Circumoral numbness

nitrous oxide in pediatric pts.

• Children who are ASA I & II all levels of sedation

• Children ASA III & IV, special needs or abnormal airways require medical clearance

• Responsible adult must accompany a child to and from an appointment and sign informed consent

• Staff certified in emergency and rescue situations

• Administration of nitrous oxide (<50%) without any other sedative, narcotic or other depressant drugs

who makes guidelines for nitrous oxide in pediatric pts. ?

American Academy of Pediatrics (AAP) and American Academy of Pediatric Dentistry (AAPD)

oversedation signs/symptoms

▪ Detachment/disassociation from environment

▪ Dreaming, hallucinating, or fantasizing

▪ Out-of-body experiences

▪ Floating and/or flying

▪ Inability to move, communicate, or keep mouth open

▪ Humming or vibrating sounds that progressively worsen

other effects a patient may experience with over sedation:

▪ Drowsiness

▪ Dizziness

▪ Diaphoresis

▪ Nausea

▪ Light-headedness

▪ Fixed eyes

▪ Uncomfortable body warmth

an overstated patient may progress to:

▪ Sluggish, delayed responses

▪ Slurred words

▪ Agitated/combative behavior

▪ Vomiting

▪ Unconsciousness

absolute contraindications

cannot be administered safely

• Pneumothorax (collapsed lung)

• Cystic fibrosis/COPD

• Pernicious anemia/vitamin B12 deficiency

• Significant bowel obstruction

• First trimester of pregnancy

• Cancer therapy

• Psychological impairment

• Current psychotropic drug use

• Current/recovering drug use

• Inability to understand procedure/informed consent

relative contraindications

can be allowed to proceed only after appropriate modifications

• Current upper respiratory infection

• Current sinus infection

• Middle ear disturbance/surgery

• Recent eye surgery (none for 6 months)