Nitrous Flashcards
Minimal sedation
Drug-induced state where patients respond normally to verbal commands. Seen with natures concentrations less than 50%. Cognitive functions and coordination may be impaired. Breathing and cardio vascular function are unaffected
Moderate sedation
Drug induced depression of consciousness during which patients respond purposefully to verbal commands. Airway and cardiovascular function maintain. Achieved with nitrous concentrations over 50%
Deep sedation
Drug induced depression of consciousness during which patients cannot easily be aroused but respond purposely after repeated or painful stimulation. Independent airway maintenance may be impaired. Cardiovascular function maintained
Conscious sedation.
Induced state of sedation characterized by a minimally depressed consciousness such that the patient is able to continuously and independently maintain a patient airway, retain protective reflexes, and remained responsive to verbal commands and physical stimulation
What are the sedation levels
Minimal sedation moderate sedation deep sedation
General anesthesia
Drug induced loss of consciousness during which patients ARE NOT AROUSABLE even by painful stimulation. Independent airway maintenance may be impaired and patient requires assistance to keep airway and need Patrice pressure ventilation.
Anxiolytics
Sedative effects
Ability to cope with a procedure depends on factors such as age, gender, previous experiences, and personality characteristics
Nitrous can produce a sense of well being, allowing a fearful or anxious patient to tolerate the situation better. Positive effect on patients pain threshold
Amnestic
Patients often state they cannot recall the severity of their pain of anxiety or anxiety or its duration. Patient perceive that time passes quickly
Analgesic
Pain control
Mixture of 20% N2O to 80% O2 has the same analgesic equiptoence as 15 mg morphine!!!! Level of pain control vanities from person to person. Useful when other drugs are contraindicated (ie allergy). Reduces fear which can help reduce pain = use nitrous before injections
Titration
Process of administering a drug incrementally to a specific level or end point of sedation. Allows for the exact amount of the drug necessary to be delivered to every patient at every appointment. Easily accomplished with nitrous (also with IV sedation but nitrous is easier to reverse)
Titration is a desirable effect
Onset of action
Rapid onset of action = clinical effects sometimes in less than 30 seconds. Peak effects in less than five minutes
Recovery
Inhalation in nitrous allows for complete recovery with 100% pure oxygen for a minimum of five minutes after turning the nitrous off. Varies from patient to patient so use a minimum of five minutes. Some patients require more time
Elimination
Natures oxide is 99% eliminated from the body within 5 to 10 minutes after the natures is turned off and the patient is allowed to breed 100% oxygen. At the end of the recovery, cognitive function is not affected. Patient may leave the office by him or herself
Acceptance
Patient typically excepts. Check to see if the patient has insurance coverage for nitrous or give your patient an estimate for treatment. In most offices, nitrous is charged out at every appointment.
Indications for use
Mild pain control, control of fear or anxiety, gag reflex – can be used during x-rays, long treatment time, local anesthetic not wanted or not tolerated well by patient – never replace the effects of local anesthetic with use of nitrous
Partial pressure gradients
Inhaled agents act on the body by moving across partial pressure gradients. Move from a higher to a lower pressure gradient. The difference between the partial pressure of a gas any liquid indicated how quickly the agent crosses The pulmonary membrane and enters into the bloodstream (blood – gas partition coefficient)
What are soluble drugs
Defuses immediately into the blood and gets distributed throughout the body. Blood – gas partition will be high, more drug and or more time will be needed to achieve equilibrium, blood – brain barrier will be crossed rapidly,onset of clinical action is not rapid.
Is nitrous soluble or insoluble
Natures is an example of a relatively insoluble drug (it remains unchanged in the blood and does not combined with any other blood elements)
Potency
Indicates how strong or powerful a drug is and how effective it is at producing anesthesia. Natures is the weakest of all inhalation general anesthetics
Toxicity
When used on healthy patients for procedures of a reasonable length, toxicity is insignificant or nonexistent. Research studies on animals and humans indicate that prolonged exposure to nitrous can have a negative fact on B12 and it’s role in the DNA synthesis
Cardiovascular system effects
Does not negatively affect the CVS. Blood flow to Oregon’s is unaffected. Blood-pressure wffects may be does related, can see decrease in blood pressure
Respiratory system affects
The patient has a condition where it is hard to breathe out of the nose insufficient amount of nitrous and oxygen will enter the respiratory system. Cold, cough, sinus infection, allergies may prevent inadequate air exchange. Not contra indicated for asthma patients. For those with other deliberated respiratory conditions nitrous may be considered a relative contraindication
Central nervous system affect
Has ability to depress the central nervous system. Evidence of injury to the central nervous system with chronic exposure can be numbness and weakness with extremities and ataxic gait = Clumsy or staggering. Can use impatiens that have a history of stroke, seizure disorder, and Parkinson’s
Hematopoietic system effects
Megaloblastic bone marrow changes have been founded patients exposed to high concentrations over a prolonged period
