Nitrous oxide: Difference between revisions

Latest revision as of 21:02, 17 May 2023

Overview

For minimal sedation or anxiolysis
It may be used as an adjunct with local anesthetics for more painful procedures

Indications

Older than 4 years and/or weighing greater than 15 kg
ASA Class 1 or 2
Sole Nitrous Oxide use examples include:
- Peripheral or Central IV placement
- Urinary catheter insertion
- Intramuscular injections
- Joint aspiration or injection
- Lumbar puncture
- Laceration repair
- Abscess incision and drainage
- Nail removal
- Wound packing or dressing change
- Foreign body removal
Nitrous Oxide + opioid or benzodiazepine examples include (smaller dosages should be used initially and titrated PRN)
- Lumbar puncture
- Laceration repair
- Abscess incision and drainage
- Foreign body removal
- Simple or minimally displaced fracture reduction

Contraindications

Nitrous accumulates in potential spaces and is potentially problematic when there are recent lung or ocular surgery.

Caution should be used when combined with benzodiazepines or other sedatives
Age less than 4 years and/or weight less than 15 kg
ASA Class 3 or above
Closed head injury, recent craniotomy, altered level of consciousness or suspicion of elevated intracranial pressure
Penetrating globe injury or recent eye surgery
Complex upper respiratory infection (obstructive sinusitis, bullous otitis media)
Maxillofacial injuries
Acute asthma, bullous emphysema or pneumonia
Pneumothorax or chest trauma
Pulmonary hypertension
Congenital heart disease
Bowel obstruction or ileus
Recent SCUBA diving, barotrauma or decompression illness
Pregnancy

Equipment Needed

Procedure

Pre-sedation establishment of an IV is not required
General monitoring procedures shall be followed
Nitrous oxide administration should be limited to 30 minutes
Administer 100% oxygen for 2-5 minutes after discontinuing nitrous oxide or if nitrous oxide / oxygen administration is interrupted for > 30 seconds

Complications

See Nitrous oxide toxicity

Asphyxia, if oxygen is not given with the gas
- Headache
- Dizziness
- Confusion
- Syncope
- Seizures
Chronic toxicity results from B12 inactivation
- Megaloblastic anemia
- Thrombocytopenia
- Peripheral neuropathy

External Links

References

Authors:

@@ Line 1: / Line 1: @@
-==Background==
+==Overview==
-Policy for the use of Inhaled Nitrous Oxide utilizing the Sedara Unit
+*For minimal [[sedation]] or anxiolysis
-in the Adult and Pediatric Emergency Departments at Harbor-UCLA Medical Center
+*It may be used as an adjunct with local anesthetics for more painful procedures
-Nitrous oxide sedation is expected to produce moderate sedation. As with all sedation agents, the
-possibility of reaching a deeper level of sedation than expected exists. Therefore, the current hospital
-policy regarding Procedural Sedation, policy number 355, will apply in its entirety to the use of this
-agent.
 ==Indications==
-Nitrous oxide is indicated for brief painful procedures in patients older than 4 years and/or weighing
+*Older than 4 years and/or weighing greater than 15 kg
-greater than 15 kg who are ASA Class 1 or 2 with the goal of minimal sedation or anxiolysis. It may be
+*ASA Class 1 or 2
-used as an adjunct with local anesthetics for more painful procedures. Examples may include:
+*Sole Nitrous Oxide use examples include:
-*Peripheral or Central IV placement
+**Peripheral or Central IV placement
-*Nasogastric tube placement
+**Urinary catheter insertion
-*Urinary catheter insertion
+**Intramuscular injections
-*Intramuscular injections
+**[[Joint aspiration]] or injection
-*Joint aspiration or injection
+**Lumbar puncture
-*Lumbar puncture
+**[[Laceration repair]]
-*Laceration repair
+**[[Abscess]] [[incision and drainage]]
-*Abscess incision and drainage
+**Nail removal
-*Nail removal
+**Wound packing or dressing change
-*Wound packing or dressing change
+**Foreign body removal
-*Foreign body removal
+*Nitrous Oxide + [[opioid]] or [[benzodiazepine]] examples include (smaller dosages should be used initially and titrated PRN)
+**[[Lumbar puncture]]
+**[[Laceration repair]]
+**Abscess [[incision and drainage]]
+**[[Foreign body removal]]
+**Simple or minimally displaced fracture reduction
-For overtly painful procedures or when additional moderate sedation is needed other agents such as
+==Contraindications==
-narcotics or benzodiazepines may be added but smaller dosages should be used initially and titrated as
+''Nitrous accumulates in potential spaces and is potentially problematic when there are recent lung or ocular surgery.''
-needed to effect. Examples may include:
+*Caution should be used when combined with [[benzodiazepines]] or other [[sedatives ]]
-*Lumbar puncture
+*Age less than 4 years and/or weight less than 15 kg
-*Laceration repair
+*ASA Class 3 or above
-*Abscess incision and drainage
+*Closed head injury, recent craniotomy, [[altered level of consciousness]] or suspicion of elevated intracranial pressure
-*Foreign body removal
+*Penetrating [[globe injury]] or recent eye surgery
-*Simple or minimally displaced fracture reduction
+*Complex upper respiratory infection (obstructive [[sinusitis]], bullous [[otitis media]])
+*[[Maxillofacial injuries]]
+*Acute [[asthma]], bullous emphysema or [[pneumonia]]
+*[[Pneumothorax]] or [[chest trauma]]
+*[[Pulmonary hypertension]]
+*[[Congenital heart disease]]
+*[[Bowel obstruction]] or ileus
+*Recent [[SCUBA diving]], [[barotrauma]] or [[decompression illness]]
+*[[Pregnancy]]
-==Contraindications==
+==Equipment Needed==
-Nitrous oxide should NOT be coadministered with ketamine, etomidate or propofol and extreme caution
-should be used when combined with benzodiazepines or opioids in light of possible synergistic effects.
-*Age greater than 4 years and/or weight greater than 15 kg
-*ASA Class 3 or above
-*Closed head injury, recent craniotomy, altered level of consciousness or suspicion of elevated
-intracranial pressure
-*Penetrating globe injury or recent eye surgery
-*Complex upper respiratory infection (obstructive sinusitis, bullous otitis media)
-*Maxillofacial injuries
-*Acute asthma, bullous emphysema or pneumonia
-*Pneumothorax or chest trauma
-*Pulmonary hypertension
-*Congenital heart disease
-*Bowel obstruction or ileus
-*Recent SCUBA diving, barotrauma or decompression illness
-*Pregnancy
 ==Procedure==
-*An authorized physician provider with procedural sedation privileges may order nitrous oxide use utilizing the Sedera unit in the adult or pediatric emergency departments.
+*Pre-sedation establishment of an IV is not required
-*An authorized patient monitor for moderate procedural sedation must be present at all times in addition to the provider.
+*General monitoring procedures shall be followed
-*Informed consent for the procedure and sedation with nitrous oxide are required.
+*Nitrous oxide administration should be limited to 30 minutes
-*A pre-sedation assessment must be performed.
+*Administer 100% [[oxygen]] for 2-5 minutes after discontinuing nitrous oxide or if nitrous oxide / oxygen administration is interrupted for > 30 seconds
-*The procedural sedation documentation record must be utilized
-*All resuscitation and monitoring equipment shall be readied and checked prior to sedation
+==Complications==
-*A new disposable facemask or mouthpiece is to be used for each administration.
+''See [[Nitrous oxide toxicity]]''
-*Pre-sedation establishment of an IV is not required.
+*[[Asphyxia]], if oxygen is not given with the gas
-*General monitoring procedures shall be followed.
+**Headache
-*Nitrous oxide administration should be limited to 30 minutes.
+**Dizziness
-*Administer 100 % oxygen for 2-5 minutes after discontinuing nitrous oxide or if nitrous oxide / oxygen administration is interrupted for > 30 seconds
+**Confusion
-*Recovery and discharge procedures shall be followed
+**Syncope
+**Seizures
+*Chronic toxicity results from B12 inactivation
+**Megaloblastic anemia
+**Thrombocytopenia
+**Peripheral neuropathy
+==See Also==
+*[[Nitrous oxide toxicity]]
+==External Links==
+==References==
+<references/>
+[[Category:Procedures]]
+[[Category:Pharmacology]]