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
Hepatic system affects
Not metabolized in the liver therefore does not affect the liver even with liver impairment
Gastrointestinal system affects
Not going to affect patients with ulcers or GERD. If you’re patient suffers from a bowel obstruction post pone natures due to the risk of expansion, pressure and discomfort
Genitourinary/reproductive system effects
No negative fact other than the possible disease transmission with equipment. Do not use in the first trimester of pregnancy, he crosses the placental barrier
Neuromuscular system affects
Natures does not provide direct skeletal muscle relaxant. Gives muscle rigidity with higher levels. No effects on patients with neuromuscular conditions. Can be used safely with multiple sclerosis, muscular dystrophy, cerebral palsy, and myasthenia gravis (autoimmune neuromuscular disease)
Mind altering conditions
Patient should be able to understand the procedure and it’s effects. Discretion should be taken when using with a recovering addict or mental illness. Severe phobics may not benefit from it, can make the situation worse
Contra indications for nitrous
Upper respiratory tract infection, pneumothorax, cystic fibrosis, emphysema, chronic bronchitis, first trimester of pregnancy, COPD, drug abuse/addiction, middle ear disturbance/Surgery, phobic patients, recent pneumoencephalography, bowel obstruction, mind altering conditions
Malignant hyperthermia
A rare life-threatening genetic condition that is usually triggered by exposure to certain drugs used for general anesthesia. Causes rapid rise and body temperature. Natures is not considered a trigger for malignant hyperthermia and maybe safely administered
Determining a good candidate for nitrous
Obtain current health history. Pay attention to patient’s current physiological status (medications), determine current level of anxiety through question on health history. Measure vital signs
What ASA levels are safe for children
Children who are classified as ASA one and ASA two are safe for sedation.
Can naturist be used on ASA three and ASA four?
Cases with ASA three and ASA four or who have special needs or abnormal airways should be carefully considered
Patient preparation. What to do before giving nitrous
Obtain a current health history, pay attention to the patient’s current physiological and psychological status such as medications. Determine current level of anxiety through questions on health history. Measure their vital signs. Advise patient to eat a light meal before the appointment and avoid heavy, fatty meals due to risk of vomiting. Obtain consent
How to estimate total liters flow per minute
The percentage of nitrous is calculated by dividing the nitrous L/min by the total L/min.
Ex. 2L/min N2O divided by 7 L/min = 28.5% N2O
Principles of recovery
Mirror image of induction; post operative 100% oxygen for 3 to 5 minutes
Recovery assessment
Technique for assessing adequate recovery includes: patient escort not needed after fully recovered. Assess patient’s response after five minutes of 100% oxygen before removing the nasal hood. I assume recovery is incomplete if patient is groggy or lightheaded. Additional oxygen maybe needed.
Post operative vital signs should be within:
10 values for blood pressure, 10 beats for pulse rate, five breaths for respiration rate
Guidelines for patient dismissal
Patients to be alert and oriented. Vital signs to be stable and within range of acceptable limits. Provide written instructions if necessary. Document! – Record that 100% oxygen was administered and know the length of time it was given
What is the recovery time for a patient
May vary from person-to-person. Operator is responsible for making judgment for dismissal
Respiratory anatomy
Any method of inhalation sedation involves inhaling and exhaling of errands and the exchange of gases. Is primarily designed to exchange carbon dioxide and oxygen across pulmonary/capillary membranes. Respiration is driven automatically by the brainstem (medulla oblongata) and voluntarily by the cerebral cortex
What does the nose do
Warms incoming air to body temperature. Humidifies the air. Filters macroparticles with nose hair and microparticles with cilia. Patient must be able to breathe well. Deviated septum him, and large tonsils or adrenoids could interfere
What does the pharynx do
A cylindrical, muscular tube 12 to 14 cm long. Divide into three sections: nasopharynx, oropharynx, and laryngopharynx
What does the Nasopharynx do
Located behind the nasal cavity. Adenoids, tonsils and openings to the Eustachian tubes I located here. Separated from the Oropharynx next by the soft palate
Oropharynx
Opens into the mouth and links the nasal pharynx and laryngopharynx . Serves as the entrance to the larynx and esophagus
What does the laryngopharynx do
Begins in the epiglottis. The epiglottis is a structure that direct material to the esophagus and prevents objects from entering the trachea during swallowing. The laryngopharynx extends from the epiglottis to the cricoid cartilage. The larynx lies inside the laryngopharynx
Anatomy of the upper airway
Nose, pharynx, nasopharynx, oropharynx, laryngopharynx
Anatomy of the lower airway
Larynx, trachea, bronchi
What is the Larynx
Houses the vocal chords. If it is irritated or obstructed, defensive cough is initiated. Nitrous does not affect cough reflex
What does the Trachea do
Begins at the sixth cervical vertebrae. Approximately 11 cm long with lumen size of 20 mm. Bifurcated into the right and left bronchi
What does the bronchi do
Carina marks that by furcation and will cause the defense cough mechanism to continue. Left bronchi is twice as long and smaller and smaller in diameter then right bronchi. because of the angle of divergence from the trachea, aspirated foreign objects are more calmly drafted into the right lobe of the long. Mainstem diverges to form the lobes of the lungs
Where are foreign objects most commonly found in the lungs
The right lobe of the lung
Anatomy of the respiratory zone
Consists of bronchiole ease, alveolar ducts, alveolar sacs, alveoli. It is in the 300 million alveoli of an adult that the exchange between air and blood takes place
Tidal flow
Refers to the automatic, regular Evan flow of air. Similar to the ocean tide
Tidal volume
Amount of gas in the lungs. Depends on the physical size and fitness of the person. Mail lung volumes are about 25% greater than females. In the normal size healthy adult and an average physical ability, the title volume is about 500 mL
What is the title volume of the normal size healthy adult of an average physical ability person
500 mL
Diffusion hypoxia
Brief diffusion in alveolar oxygen tension. As nitrogen exits faster than nitrogen that replaces it, oxygen is diluted/reducing oxygen saturation and diffusion hypoxia can occur. Oxygen saturation levels are considered normal at 98 to 100%
Signs and symptoms of nitrogen/oxygen sedation
Varies among people; intense for some people and mild for others. Science maybe obvious or sub tile. Constantly monitor because the levels of sedation me crease as a patient relaxes. Certain physical physiological and psychological effects may/can result
Appropriate minimal sedation appearances
Patient becomes relaxed and comfortable and acknowledges this state. Deeper breaths with relaxation. I movement will begin to slow with relaxation and I may appear glazed or glassy. Reduced signs of tension in facial expression. Patient is able to respond to simple commands.
Signs and symptoms of oversedation
Detachment. Dreaming or hallucination. Out of body experience, floating or flying sensation. Unable to move, talk, or keep mouth open. Intolerant to humming or vibrating sound previously tolerated. May experience: drowsiness, dizziness, nausea, lightheadedness, fixed eyes, overly hot. May progress: sluggish, slur words, irritated/combative, vomit, unconsciousness
Natures use in pediatrics
Guarding the patient safety and welfare, minimizing physical discomfort and pain, controlling anxiety and minimizing amnestic potential, controlling behavior and
Criteria for pediatric recovery
Vital signs are within normal ranges, airway is patent in uncompromised, patient is easily aroused with intact protective gig and cough reflexes, they should contact, set up, and walk without assistance, document the procedure as you would for an adult
Is weight a consideration for natures administration
No
What is the typical flow rate for a pediatric patient
5 to 6 L per minute
Chronic exposure
Is an issue of debate and concern: possible reproductive problems. Perceptual cognition and psycho motor skills
Specific biologic issues and health concerns from nitrous
Inactivation of methionine synthesis. Is an enzyme associated with vitamin B 12 metabolism. Vitamin B 12 is necessary for DNA synthesis and cellular reproduction
Detection and monitoring of
Infrared spectrophotometry used to detect levels of nature is in the atmosphere at levels lower than one part per million.
Badges are worn for a period of time then sent for analysis
Scavenger nitrous
Minimal trace amounts of gas before, during, or after use by the patient. Leaking of gases can come from the patient talking and expelling natures into the operators breeding zone. Ill fitting masks can cause leaks
Leaks
Always check equipment for cracks or holes, suspect a leak, use the soap bubble technique: put soapy water in an area of suspected leak, the presence of bubbles after the application indicates a gas leak. Have adequate ventilation: fresh air inlets be located in the ceiling and designated to direct fresh air supply towards the floor to ensure adequate delusion and mixing a waste gases
Three categories of inhalants
Volatile solvents, nitrates and N2O2
What is abuse more: solvents or nitrates
Solvents
Inhalants
Apply to a group of substances that produce psychoactive reactions and are defined solely by the route of administration. Natures is considered an inherent
And Haley is achieving a quick comment exhilarating hi usually last about a minute: people have feelings of flying, seen colorful images, and Liz inhibitions
What population is nitrous abuse usually seen in
Older population
Nitrous side effects
Peripheral neuropathy (tingle and numbness), weakness in in cordon nation, lack of strength and dexterity in hands, slow gait, and electrical shock feeling on the bending of the neck
