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PEDO (Spring) > 6. Nitrous Oxide > Flashcards

6. Nitrous Oxide Flashcards

1
Q

Advantages of N2O

A
  • Ease of Use
  • Wide margin of safety
  • Rapid reversibility
  • Analgesic and anxiolytic
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2
Q

Who first synthesized N2O

A

Joseph priestley

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3
Q

Who was credited the discoverer of N2O anesthetic

A

Horace Wells

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4
Q

Who first discovered the effects of inhaling N2O

A

Humphry Davy

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5
Q

Properties of N2O

A
  • Odorless (or sweet smelling)
  • Colorless
  • Slightly heavier than air
  • Anxiolytic and analgesic
  • Minimal impairment of reflexes
  • Low solubility in blood (rapid onset and recovery)
  • Doesn’t bind hemoglobin or undergo biotransformation (held in serum portion of the blood)
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6
Q

Is N2O considered a general anesthetic

A

yes

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7
Q

What variable measures the potency of a general anesthetic and define in

A

MAC (Minimal alveolar concentration)= the concentration of anesthetic needed to cause immobility in 50% of patients

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8
Q

MAC of N2O is

A

105

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9
Q

Describe the mechanism of how N2O –> analgesia

A
  • Increases the bodies production of endogenous opiods
  • Direct interaction with opiod receptors
  • Interaction with the GABA (A) receptor
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10
Q

30% nitrous is the equivalent to what dose of morphine

A

10-15mg

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11
Q

Describe the mechanism of the anxiolytic effects of N2O

A

Activation of the GABA A receptors through the benzo binding site

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12
Q

Objectives of N2O

A
  • Reduce or eliminate anxiety
  • Reduce movement and reaction to dental treatment
  • Enhance communication and cooperation
  • Increase tolerance for longer appointments
  • Aid in treatment of mentally/physicalyl disabled or medically compromised patients
  • Reduced gagging
  • Potentiate the effect of sedatives
  • Raise the pain threshold
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13
Q

Raising the pain threshold with N2O can be enhanced by

A

distraction

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14
Q

How does N2O increase the child’s pain threshold

A

-Analgesic properties

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15
Q

T/F N2O will not eliminate the need for LA in most kids

A

t

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16
Q

Disadvantages of N2O

A
  • Low potency
  • Relies of psychological reassurance (not a replacement for behavior guidance)
  • Nasal hood in the way for a maxillary anterior injection
  • Environmental and occupational health hazard
  • Patient must breath through their nose (nasal polyps, deviated septum, URI and nasal obstruction prevent its use)
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17
Q

Indications for N2O

A
  • Fearful, anxious or obstreperous patient
  • Special care needs
  • Profound LA can’t be obtained
  • Lengthy procedure
  • Reduce gag reflex
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18
Q

Adverse effects of N2O

A

-Most common adverse effect is Nausea and vomitting (occurs in 0.5% of patients)

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19
Q

How is vomitting exacerbated with N2O use

A
  • Use for long amount of time
  • Conc. N2O= too high
  • Large fluctations of N2O conc.
  • Rapid induction and reversal (titration not used)
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20
Q

Contraindications for N2O

A

-Can’t Everyone Please Be More Conscientious

COPD

  • Not asthma (N2O may help by alleviating anxiety that can trigger and asthmatic attack)
  • People with severe pulmonary diseases that use hypoxic drive to stimulate breathing rather than CO2 accumulation
  • ^^These epopel are more sensitive to the sedative effects and can stop breathing)

Emotional Disturbances

  • More sensitive to sedation
  • More prone to hallucinations

Pregnant

  • Spontaneous abortion
  • Potential impact on developing fetus

Bleomycin Sulfate

  • Anti-neoplastic drug
  • High oxygenation isn’t advisable can cause respiratory failure

Methylenetetrahydrofolate reductase (MTHFR) deficiency

  • MTHFR deficiency –> increased amounts of homocysteien
  • N2O increases homocysteine conc.

Colbalamin (VitB12) deficency

  • N2O irreversibly inhibits the cobalt atom of B12
  • Decreased activity of B12 enzymes such as methionine and thymidylate synthetase
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21
Q

Effect of N2O on a patient with otitis media

A
  • N2O is more soluble in blood than N2 which results in filling empty spaces with air
  • Increases middle ear pressure –> pain
  • Air may enter the tympanic space and rupture the ear drum
22
Q

Entrapment of air is an issue where in the body

A
  • Ear in otitis media
  • GI in bowel obstruction
  • Intraocular after retinal surgery
23
Q

Have there been any reported allergies to N2O

A

no

24
Q

NPO guidlines for N2O

A

Child doesn’t have to be NPO

-May recommend a light meal 2 hrs before

25
Q

The smallest nasal hood is

A

Dynomite (disposable and scented nasal hood)

26
Q

Define Tidal Volume

A

The amount of gas that flows in and out of the lungs during quiet breathing

27
Q

Normal tidal volume for adults and kids is usually

A 
Adult= 500 mL
Child= 250 mL (1/2 the adult)
28
Q

Define Minute Volume

A
  • Product of the tidal volume and respiration rate

- Amount of air that is inhaled and exhaled per minute

29
Q

Normal minute volume is

A

6-7 L/min

30
Q

Gass flow should be the same as

A

the minute flow (notes say tidal volume??)

31
Q

As the child ages the tidal volume (increases/decreases) and the respiration rate (increases/decreases)

A

increases…decreases

32
Q

Flow rate of _-_L/min is generally acceptable for most patients

A

4-6L/min

33
Q

How do you know if you should adjust the flow rate

A

Look at the reservoir bag

-Should be 2/3rds full and pulsate with breathing

34
Q

Which technique is perfered (rapid inducation/titration)

A

titration (more safe)

35
Q

Conc. of N2O shouldn’t exceed

A

50%

36
Q

Typical patient requires -% N2O for ideal sedation

A

30-40

37
Q

DESCRIBE THE TITRATION TECHNIQUW

A
  • START N2O AT 10%
  • Wait ~30-60 secs looking for signs of sedation
  • Increase N2O by 5-10% intervals until optimal sedation
38
Q

Signs of optimal sedation

A
  • Ptosis of eyelids
  • Staring off into space
  • Relaxation of limbs and jaw
  • Palms are warm, moist and open
  • Pitch in voice changes
  • Lowered heart rate
  • Patient reports feeling relaxed
39
Q

Describe the rapid induction technique

A

indicated when you have a kid that may be on the edge of losing coping abilities
-Administer 50% N2O immediately

40
Q

Early sign of CNS effects of N2O

A

Tingling sensations in fingers and toes

-In kids instead of asking minimal or continual movement of fingers and toes is indication of CNS effects

41
Q

Describe the technique to relax claustrophobic patients with N2O that don’t like the nasal hood

A
  • N2O is slightly heavier than air
  • Hod the hood at 30% O2 3 inches from face until kid relaxes
  • bring hood closer until in position
42
Q

Use of rubber dam (helps/inhibits) N2O effects

A

helps (facilitates nasal breathing)

43
Q

O2 deliverance at the end of the procedure should be for how long

A

100% O2 for 3-5 min

44
Q

Describe diffusion hypoxia

A

-Result of rapid release of N2O from alveoli resulting in dilution of O2

45
Q

Side effects of inadequate oxygenation are

A
  • dizziness
  • Light headed
  • Nausea
  • *All can be relieved with oxygenation
46
Q

When is diffusion hypoxia a concern

A
  • High conc. of N2O used (70%)
  • Closed system (full mask or endotracheal tube)
  • AKA hospital/ OR setting
47
Q

What are the benefits of delivering 100% O2 at end of procedure

A
  • Expired nitrous into scavenging system in nasal hood

- Prevent diffusion hypoxia (even though unlikely)

48
Q

What should be monitored during treatment

A
  • Respiration rate
  • Level of conciousness (spoken response= indication of breathing)
  • Color
49
Q

Documentatino after N2O use

A
  • Informed consent
  • Indication
  • N2O dosage
  • Duration of procedure
  • Post treatment oxygenation procedure
50
Q

Good O2 Hygiene includes

A
  • Scavenging system
  • Large operatory
  • Rapid room air exchange
  • Supplemental air movement (fans)
  • Nasal hood adapts close to nose
  • Periodic monitoring (dosimetry badge)
51
Q

N2O occupational Hazards

A
  • Spontaneous abortion (practitioner and spouse)
  • Some cancers
  • Liver disease (exposure longer than 3 hrs per week)
  • Kidney disease
  • Neurologic disease
  • Long term exposure –> decreased fertility
  • Congenital malformaitons

PEDO (Spring) (9 decks)

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