Nitrous Oxide and Oxygen Sedation- Ch 3/4- COMPLETED

it has been reported that as many as how many people in the U.S avoid the dentist due to fear?

35 million

Pain

Defined as unpleasant sensory and emotional experience associated with actual or potential tissue damage

Pain is multifactorial

Objective of pain is to alert the central nervous system to provide damage protection

Noted by pain receptors that are non-specialized

Pain is subjective and interrelated to fear

Things that effect pain

Mental

Social

Cultural

Emotional

Physiological

Managing Pain and its benefits

It benefits the patient by relaxing them and increasing compliance

It also benefits the clinician because a relaxed patient is easier to work on and more comfortable

A pain scale is commonly used

Anxiety

Defined as uneasy feeling of discomfort or dread accompanied by an autonomic response to a feeling

Feeling of apprehension caused by an anticipation of danger

Accompanied by restlessness, tension, tachycardia

Interrelated to fear

Fear

Defined as a feeling of fright or dread related to an identifiable source recognized by the individual

Fears often stem from previous experiences

Fears can be influenced from other's experiences

Signs of fear:

• Sweating

• Crying

• Refusal to cooperate

• Obsessive talking

• White-knuckle syndrome

Meet fear with all of the following

• Empathy

• Warmth

• Respect

• Understanding

Sedation

Because sedation is an individual response, it can be difficult to predict an outcome. It is important to know how to rescue a patient if the sedation moves to the next level of the continuum.

anxieity/pain management

Several options for management of pain/anxiety

• noninvasive

  words or actions

• hypnosis

• acupuncture

• systematic desensitization

• distraction

• TENS

• local anesthesia

LOCAL ANESTHESIA IS THE BACKBONE OF DENTISTRY

local anesthesia has several methods available

1. oral​

medication prior to appt

2. intramuscular​

directly injected into muscle

3. inhalation​

NITROUS OXIDE

4. intravenous

Directly injected into circulatory system

Desirable characteristics of nitrous oxide/oxygen sedation

Analgesic (pain control)

Anxiolytic (sedative effects)

Amnestic

Onset of action

Titration

Length and depth of sedation

Elimination and recovery

Acceptance

Pain control and sedative effects

Pain control is variable based on individual: has the ability to raise pain threshold prior to injection

Fear affects ability to tolerate pain, nitrous has the ability to manage both

Nitrous can help decrease anxiety by producing a sense of well-being, allows patient to become relaxed

In pediatric patients it promotes positive behavior and lowers anxiety on sequential visits

Onset of action

Nitrous oxide has a rapid onset of action, beginning within 30 seconds

Very similar to iv with onset

ELIMINATION AND RECOVERY

Nitrous oxide is eliminated through lungs so happens much faster

Full physical and cognitive recovery is facilitated with 100% oxygen

No escort needed but do need to evaluate the patient prior to leaving

titration

Defined as the process of administering a drug incrementally to a specific level of endpoint of sedation

Method that prevents unintentional overdose

Not possible with oral medications or IM administration

Also used with iv sedation but isn't as with nitrous oxide

Length and depth of sedation

Nitrous allows us to tailor the length and level of sedation

If sedation is done properly the patient will not incur negative side effects

Acceptance

Patients and parents like the use of nitrous oxide

Nitrous oxide and other sedation methods

Useful combinations

• Using relaxing words

• Distraction(headphones)

• Oral medications (benzodiazepines)

• Local anesthesia

When using combinations

• Additional drugs will poss lead to deeper sedation, it is the operator's responsibility to be able to manage deeper sedation

• Combination of nitrous and local is very effective and often used together