nitrous oxide: contraindications and complications

what is an absolute contraindication

condition where nitrous oxide should not be used bc the risks outweigh the benefits

what is a relative contraindication

a condition where nitrous oxide may be used with caution, depenfing on the pt med status and provider’s judgement

why is pneumothorax an absolute contraindication?

nitrous oxide rapidly expands into closed air spaces, making the pneumothorax larger and maybe life threatening

why is nitrous oxide contraindicated in patients with COPD

patients w copd rely on low oxygen levels

why should nitrous oxide be avoided during the first trimester of pregnancy

bc organ development occurs during first trimester, avoid unnecessary exposure to medications

why may a pt w severe psych impairment not be good candidates for nitrous oxide

may be unable to understand instructions, cooperate, or accurately communicate how they are feeling during tx

why ca nitrous oxide be problematic in patients with sinus infections, colds, or nasal congestion

bc pt must breathe comfortably through the nose for nitrous oxide to be effective

why should nitrous oxide be used cautiously in patients with middle ear disease or recent ear surgery

nitrous oxide expands into air-filled spaces, increasing pressure in the middle ear and potentially causing pain or injury

why is a recent retinal surgery involving a gas bubblr a contraindication

nitrous oxide can rapidly expand the gas bubble, increasing pressure inside the eye and risking permanent vision damage

why should nitrous oxide be used cautiously in patients with vitamin B12 deficiency?

nitrous oxide can inactivate vitamin B12, which is necessary for normal nerve function and DNA synthesis

common side effects of nitrous oxide

nausea

vomitng

dizziness

headache

sweating (usually w oversedation)

common cause of nausea during nitrous oxide sedation

oversedation

rapid concentration changes

large meals before tx

long procedures

how can nausea be minimized

titrate slowly

avoid excessive concentrations

encourage a light meal beforehand

finish with 100% oxygen

how is occupational exposure reduced

proper scavenging sys

good ventilation

well-fitted nasal hood

checking equipment for leaks

why is equipment maintenance important

prevents gas leaks, improves pt safety, and reduces staff exposure

why should patients be encouraged to breathe trhough their nose?

mouth breathing decreases the amount of nitrous oxide inhaled and increases waste gas escaping into the room

why is nitrous oxide called an ideal outpatient sedative

bc of rapid recovery, easy titration, quick recovery, minimal metabolism, excellent safety record