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Pain and Anxiety > L6 Nitrous Oxide Sedation > Flashcards

L6 Nitrous Oxide Sedation Flashcards

1
Q

What is nitrous oxide made of

A 
Dinitrogen monoxide (g)
Stored as a liquid
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2
Q

What are properties of N2O

A
  1. Analgesic (like morphine)
  2. Anxiolytic
  3. Colourless
  4. Non-flammable
  5. Slightly sweet
    odour
  6. Low solubility in blood
  7. Rapidly diffuses across membrane
  8. Excreted unchanged from lungs
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3
Q

What affects does nitrous have on BP and heart rate?

A

No change to BP (if at all a slight increase)

No effect on HR

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4
Q

Where does N2O act?

A

On opioid receptors in the mid-brain - same is morphine and heroin

Descending inhibitory pathway
Altering pain processing in the spinal cord

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5
Q

What do the effects of N2O feel like?

A

Alcohol

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6
Q

What is the common percentage of N2O

A

40-70%

Usually used with other things as well - ex. will not be used alone for GA

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7
Q

What is the onset time of nitrous?

A

2-5 minutes

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8
Q

What are potential uses for nitrous?

A

Start GA
Titrate GA
Anxiolytic
Reduce pain

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9
Q

What must be given in first and last 5 minutes?

A

Oxygen

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10
Q

What is a general effect of N2O?

A

Calm, comfortable, relaxed, reduced fear/anxiety

Aware patient, that responds, but has a glazed look in eyes

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11
Q

What are the general sensations people feel from nitrous?

A
  1. tingling extremities
  2. heaviness, heaven ness
  3. warmth
  4. Chills
  5. Floating sensation
  6. Vasodilation

Loss of gag reflex

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12
Q

What is involved in the metabolism of N2O

A

Oxidizes cobalt enzyme of vitamin b12

– b12 required for myelin sheath synthesis

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13
Q

Pressure volume problems

A

N2O pressure is 31x more than N2

N2O physically replaces N2 and increases the volume +/or pressure of that space

N2O 34x more soluble in blood, replacement of N2 faster than N2 is taken out, increasing pressure in air filled spaces

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14
Q

What are some benefits of nitrous?

A

Good for long procedure, good for pain and anxiety, quick and easy to reverse, easily titratable
Still lets people have protective reflexes, with few side effects

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15
Q

Is nitrous stored in body or metabolized by the liver?

A

Neither

99% eliminated through lungs without biotransformation

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16
Q

What are indications for nitrous?

A 
Fearful anxious patient 
Special health care need
Strong gag reflex 
Profound LA can't be obtained
Lengthy procedure
17
Q

What are contraindications for nitrous?

A 
Lung issues
Phychological issues
Pregnancy
Bleomycin sulfate (a cancer med for SCC)
B12 efficiency 
Pulmonary hypertension
Severe cardiac disease
Claustrophobia 
Congestion, nasal probs
Resp tract infections
Full meal
Cystic fibrosis 
Pneumothorax, middle ear probs, eye surgery, hyperthermia
18
Q

What are the names of the nitrous machine we use?

A

Accutron or porter

19
Q

What colour is the oxygen side?

A

White/green

20
Q

What colour is the nitrous side

A

Blue

21
Q

Requirements for nitrous

A

5 cases per year in log book, re-register q5yr

22
Q

To certify in nitrous

A

6 cases and a 6 hour course

23
Q

What is the minimum oxygen percentage delivery?

A

30%

24
Q

What percentage of nitrous patients don’t receive enough sedation?

A

3%

25
Q

Why do patients not achieve enough sedation?

A

Claustrophobia
Need more than the 70% nitrous system can deliver
Too fearful

26
Q

Is vomiting possible from nitrous?

A

Yes, position upright, suction and assess for aspiration

27
Q

What is diffusion hypoxia?

A

After sedation N2O leaves the body relatively unaltered through the lungs.
N2O will leave faster than N2 can replace it –> diluted supply of O2 and reducing O2 blood saturation

This is why we need 5 mins of Oxygen

28
Q

Symptoms of acute nitrous exposure

A 
Dizzy
hard to breath
headache
nausea
fatigue
irritability
loss of consciousness
29
Q

Chronic exposure symptoms

A 
tingling
numbness
mental performance
manual dexterity
adverse reproductive effects
30
Q

What does it mean to minimize N2O pollution

A 
Minimize talking
Scavenge area of mixing unit
Turn the tank off all the way 
cannot use any cracked stuff
pressure test
31
Q

Office air zones for nitrous

A
  1. patient zone - within 10 cm from nose
  2. operator zone - 36-72 cm away from pt nose
  3. operators zone - whole op with nitrous oxide use
  4. office zone - all areas outside of operators served by same ventilation system
32
Q

What are the zones we’re concerned about?

A

2 and 3

33
Q

What is the limit for nitrous use per day?

A

30 minutes to maintain a 25 ppm safety level

Pain and Anxiety (7 decks)

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