Nitrous oxide: Difference between revisions
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== | ==Overview== | ||
For | *For minimal [[sedation]] or anxiolysis | ||
*It may be used as an adjunct with local anesthetics for more painful procedures | |||
==Indications== | ==Indications== | ||
*Older than 4 years and/or weighing greater than 15 kg | *Older than 4 years and/or weighing greater than 15 kg | ||
*ASA Class 1 or 2 | *ASA Class 1 or 2 | ||
*Sole Nitrous Oxide use examples include: | |||
*Peripheral or Central IV placement | **Peripheral or Central IV 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 | |||
==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== | ==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]]'' | |||
*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 | ||
* | **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]] | |||
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
- 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