Nitrous oxide: Difference between revisions
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**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) | *Nitrous Oxide + [[opioid]] or [[benzodiazepine]] examples include (smaller dosages should be used initially and titrated PRN) | ||
**Lumbar puncture | **[[Lumbar puncture]] | ||
**Laceration repair | **[[Laceration repair]] | ||
**Abscess incision and drainage | **Abscess [[incision and drainage]] | ||
**Foreign body removal | **[[Foreign body removal]] | ||
**Simple or minimally displaced fracture reduction | **Simple or minimally displaced fracture reduction | ||
==Contraindications== | ==Contraindications== | ||
''Nitrous accumulates in potential spaces and is potentially problematic when there are recent lung or ocular surgery.'' | ''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 | *Caution should be used when combined with [[benzodiazepines]] or other [[sedatives ]] | ||
*Age less than 4 years and/or weight less than 15 kg | *Age less than 4 years and/or weight less than 15 kg | ||
*ASA Class 3 or above | *ASA Class 3 or above | ||
*Closed head injury, recent craniotomy, [[altered level of consciousness]] or suspicion of elevated intracranial pressure | *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) | *Complex upper respiratory infection (obstructive [[sinusitis]], bullous [[otitis media]]) | ||
*Maxillofacial injuries | *[[Maxillofacial injuries]] | ||
*Acute asthma, | *Acute [[asthma]], bullous emphysema or [[pneumonia]] | ||
*[[Pneumothorax]] or [[chest trauma]] | *[[Pneumothorax]] or [[chest trauma]] | ||
*[[Pulmonary hypertension]] | *[[Pulmonary hypertension]] | ||
*Congenital heart disease | *[[Congenital heart disease]] | ||
*Bowel obstruction or ileus | *[[Bowel obstruction]] or ileus | ||
*Recent [[SCUBA diving]], [[barotrauma]] or decompression illness | *Recent [[SCUBA diving]], [[barotrauma]] or [[decompression illness]] | ||
*[[Pregnancy]] | *[[Pregnancy]] | ||
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*General monitoring procedures shall be followed | *General monitoring procedures shall be followed | ||
*Nitrous oxide administration should be limited to 30 minutes | *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 | *Administer 100% [[oxygen]] for 2-5 minutes after discontinuing nitrous oxide or if nitrous oxide / oxygen administration is interrupted for > 30 seconds | ||
==Complications== | ==Complications== | ||
*Asphyxia, if oxygen is not given with the gas | ''See [[Nitrous oxide toxicity]]'' | ||
*[[Asphyxia]], if oxygen is not given with the gas | |||
**Headache | **Headache | ||
**Dizziness | **Dizziness | ||
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**Megaloblastic anemia | **Megaloblastic anemia | ||
**Thrombocytopenia | **Thrombocytopenia | ||
**Peripheral | **Peripheral neuropathy | ||
==See Also== | ==See Also== | ||
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