Nitrous Oxide Sedation in Pediatric Dentistry

Nitrous Oxide Sedation in Pediatric Dentistry Mark H. Taylor, D.D.S.

History of N2O ,[object Object],[object Object],Dr. Horace Wells

N2O Commonly Used (and misused) 88% of Pediatric Dentists use N2O, and about 58% of general dentists use N2O. Deadheads inhaling N2O from a balloon.

Purpose of Nitrous Oxide Sedation ,[object Object],[object Object],[object Object]

Fear Reduction & N2O ,[object Object],[object Object],[object Object],Veerkamp, et al, J Dent Child , May-June 1993

Fear Reduction & N2O ,[object Object],Veerkamp, et al, J Dent Child , Jan-Feb 1995

Increase Pain Reaction Threshold

Four Stages of Anesthesia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],The patient is unconscious in Stages 2, 3, and 4.

Four Plateaus of Analgesia ,[object Object],[object Object],[object Object],[object Object]

N2O Should Be Used To: ,[object Object],[object Object],[object Object],[object Object]

N2O Should Not Be Used To: ,[object Object],[object Object],[object Object]

Uptake and Saturation of N2O Blood Tissue Saturation PROBLEMS!!! Less Uptake N2O from Lungs Lungs Effective PP in Brain Increase Lung N2O Concentration Highly Perfused Tissues

Signs of Saturation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Monitor Frequently

Reduce N2O Dosage... ,[object Object]

Inhalation Analgesia Permits - State of Nebraska ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Elimination of N2O ,[object Object],[object Object],[object Object]

Diffusion Hypoxia ,[object Object],[object Object],Ventilate the patient for 3 to 5 minutes to prevent diffusion hypoxia!

Effects on Systems ,[object Object],[object Object],[object Object],[object Object],[object Object]

Effects on Systems ,[object Object],[object Object],[object Object],[object Object]

Myocardial Depression with N2O Use in CHF Patients

Effects on Systems ,[object Object],[object Object],[object Object]

Effects on Systems ,[object Object],[object Object]

Chronic Exposure to N2O “ Long-term (chronic) exposure to nitrous oxide in sufficient concentrations can produce irreversible, toxic changes, and should be a concern for dental personnel working in environments in which nitrous oxide is administered to patients.” Howard, JADA, March 1997

Chronic Exposure Disorders ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Neurological Symptoms of Chronic Exposure ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Uh, whaa ja’ say????

Safe Concentrations of N2O ,[object Object],[object Object],[object Object]

Safe Concentrations of N2O Nitrous Oxide Guidance ADA met with OSHA's second in command, Deputy Assistant Secretary James Stanley, Sept. 18 after learning that a draft OSHA "technical guidance" document on anesthetic gases apparently imposes on dental offices a nitrous oxide level of 25 ppm, a level technologically out of reach and far below that associated with adverse health effects. ADA pointed out that the Association's expert panel, which met Sept. 12 and 13 and included an OSHA engineer, agreed the 25 ppm level is unjustified by scientific data. ADA will submit written comments on the OSHA draft by the end of October. (September 26)

Safe Concentrations of N2O ,[object Object]

N2O Scavenging ,[object Object],[object Object],[object Object],[object Object],[object Object]

Controlling N2O in the Operatory ,[object Object],[object Object],[object Object],[object Object],Howard, JADA, March 1997

Controlling N2O in the Operatory ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Howard, JADA, March 1997

Controlling N2O in the Operatory ,[object Object],[object Object],[object Object],[object Object],[object Object],Howard, JADA, March 1997

Controlling N2O in the Operatory ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Howard, JADA, March 1997

N2O Scavenging ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Preparation of Patient ,[object Object],[object Object],[object Object],This is how its gonna be, kid...

Administration of N2O ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Complications/Precautions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Hallucinations ,[object Object],Always have an assistant present!

Complications/Precautions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Complications/Precautions ,[object Object],[object Object]

Nitrous Oxide Sedation in Pediatric Dentistry

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Nitrous Oxide Sedation in Pediatric Dentistry