Inhalation Sedation - Nitrous Oxide Flashcards
What MUST N2O documentation include and what SHOULD it include?
Must:
1. Informed consent obtained and documented in chart
2. Percentage of N2O administered
3. Lenght of time pt was sedated
4. Flow rate of gases during aministration
Should:
5. Indication for use of N2O
6. Pt response and tolerance
What does nitrous oxide provide
Ideal sedation
- produces analgesic and anxiolytic effects
- rapid onset (2-5 mins)
- wide safety margin
- quick recovery time
- no “hangover” effect
What are properties of nitrous oxide
- low solubility in blood = rapid onset
- diffuses rapidly across alveolar-arterial membrane
- excreted unchanged through lungs (insoluble in blood)
- can induce unconsciousness at high concentrations (70% or higher)
- no effect on HR
- no effect or slight increase in BP
- equivalent to therapeutic dose of morphine
- crosses Blood-brain barrier
- crosses placenta
What are indications for nitrous oxide sedation
-Patients with anxiety
-Patients with a tendency to faint
-Patients with a strong gag reflex
-Medically compromised patients
-Angina pectoris
-Post MI
-Post CVA
What is an absolute contraindication and examples
- administration of drug increases possibility of life threatening situation - Do NOT administer under any circumstances
Ex:
1) Nasal Obstruction
2) Vit B12 deficiency
3) Alcoholic/Recovering Addict
4) Uncommunicative (disability or language barrier)
4) Patient Refusal
What is a relative contraindication and examples
Administration of drug is preferably avoided due to possible adverse reactions - administer judiciously
Ex:
1) Middle ear infection
2) Balance disorder
3) Susceptibility to motion sickness
4) Claustrophobia
5) Pulmonary Diseases
6) Immunocompromised
7) Pregnancy
8) Psychiatric Disorders/Bipolar
9) Marijuana or Hallucinogenic drug use
What are the side effects of nitrous oxide sedation
-Nausea*
-Vomiting*
-Headache (technique)*
-Dysphoria
-Dizziness
-Hallucinations
What are effects of long term exposure to nitrous oxide
- bone marrow suppression
- reproductive system disturbances (spontaneous absorption, premature delivery, infertility)
- neurological deficits (numbness, paresthesia, impaired equilibrium, difficulty concentrating)
- possible hepatotoxicity
What color is oxygen
Green
What color is nitrous oxide
Blue
What is the flush button
Fills reservoir bag
- can be used for over-sedation
What is the oxygen fail safe mechanism
O2 at 30% minimum, N2O at 70% max (required by law)
If O2 stops flowing the machine will shut off
What are the steps for nitrous oxide administration
1) Select appropriate nasal hood size
2) Inflate (flush) the reservoir bag - start w/ 5-6 L/min flow rate of 100% O2
3) Place the nasal hood, adjust, tighten
4) Instruct pt to breathe normally - adjust the flow rate
5) Gradually titrate N2O-O2 in 10% intervals, watching for signs of sedation - ask how they feel
6) Typical pt requires 50%N2O-50%O2
7) When tx is completed, N2O to zero and increase O2 to re-establish flow rate –> 100% O2 for 5 minutes
8) Document the procedure
**NEVER leave the pt unattended
What is significant in the scavenging hood?
Has pathway for exhaled air to go
What are the safety features in N2O equipment
-Pin index safety system: cannot inadvertently reverse tanks
-Oxygen fail safe: N2O flow terminated if O2 delivery pressure falls
-Emergency Air Inlet: allows atmospheric air in if flow of gases stops
-Oxygen Flush Button: rapid delivery of high flow O2 to patient (oversedation)
-Color coding
