10-Nitrous Oxide Pt. 2 Flashcards
T/F there are no contraindications with N2O and the cardiovascular system
true
sometimes it’s beneficial for them (e.g. suspected MI: morphine or 50% N2O)
with the respiratory system which disease would we be most concerned about?
severe COPD
when will we want to avoid using nitrous with the respiratory system?
Gas retention with increased pressure– avoid use
Sinusitis
Middle ear disturbance/surgery
Cystic fibrosis & severe COPD– bullae as consequence of disease
Pneumothorax
Certain recent ophthalmic surgeries
T/F you can’t do nitrous if the pt has anemia
false
no contraindications with N2O and hematopoietic system
T/F with the endocrine, hepatic, GI, genitourinary, and neuromuscular systems you are ok to do N2O
true
what chemotherapy drug is a contraindication for N2O?
Bleomycin sulfate therapy
increases incidence of pulmonary fibrosis and other pulmonary diseases
what surgery is contraindicated for N2O?
Vitreoretinal surgery – gas bubble placed to assist healing
Middle ear – tympanic membrane rupture, graft displaced
what drugs are contraindicated for N2O?
Antidepressants or psychotropic drugs
Recovering alcohol and drug addicts
when taking meds to induce sleep (Combined oral/inhalation sedation – increased depth)
what gene mutation is contraindicated with N2O? what happens?
MTHFR (involved with vit. B12 prod)
can result in irreversible, catastrophic neurological damage or even death
how long should a pregnant mother be exposed to N2O if needed for tx?
30 min
what trimester can a pregnant pt use N2O?
2nd/3rd
what percentage of O2 should be used if using N2O on a pregnant woman?
50%
what happens with chronic N2O and pregnancy?
can cause cellular abnormality in animals (inactivation of methionine synthetase and vit B12)
N2O affects Vit ______ metabolism
B12
who are the primary victims of overexposure to N2O?
dentists or other helathcare providers delivering w/o scavenger systems
what can a pt experience with N2O?
sexual phenomena
can accuse you of sexual assault while under drug effect
make sure another person is present
what can unscavenged N2O do to you?
irreversible toxic changes associated with reproductive, neurological, hematological, immunological, renal and liver disease
what reproductive effects does occupational exposure of N2O do to you?
Exposure to high levels of unscavenged N2O can decrease fertility
Exposure to high levels of unscavenged N2O can increase levels of spontaneous abortion and low birth weight
There is no significant increase in congenital abnormalities
what neurological effects does occupational exposure to N2O do?
Neurological symptoms are loss of ability to concentrate, numbness of the extremities, paresthesia, ataxia, impotence, and loss of bladder and bowel sphincter control
what are the health hazards with recreational abuse of N2O?
Chronic abuse
Hemotologic
Leukopenia
Megaloblastic changes
Pernicious anemia
Neurologic
Numbness – arm, legs, trunk
Equilibrium, gait disturbance
Impotence
Sphincter control
Inability to work, difficulty thinking
what are the constituents of earth atmosphere?
78% - nitrogen
21% - oxygen
1% - trace amounts of various gases
there is a major difference in partial pressure gradients b/t N2O and _____
N2 (nitrogen)
in high amounts in natural air and will displace N2O
what solubility do you want?
Low solubility -
Blood-brain barrier crossed quickly
Equilibrium quickly achieved
Rapid onset
T/F N2O is relatively soluble
false
insoluble
T/F N2O is not metabolized by the liver
true
N2O is the _________ inhalation agent?
least potent
what is MAC?
minimum alveolar concentration
Amount of drug to prevent movement in 50% of patients subjected to surgical incision
MAC for N2O is 104-105%
Therefore, unable to produce surgical anesthesia by using nitrous alone, even if the patient was breathing 100% nitrous
