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Peds 2 > Nitrous Delivery Systems > Flashcards

Nitrous Delivery Systems Flashcards

1
Q

what are the four main divisions of nitrous delivery systems?

A
  • demand flow units
  • continuous flow units (what we use in dentistry)
  • portable
  • central (more complex)
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2
Q

what is the biggest source of contamination for Nitrous?

A

talking

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3
Q

what do regulators do?

A
  • reduce pressure from 750-2200 psi to a safe 45-55 psi
  • only used with central systems
  • uses grease (cannot use petroleum based products w O2 lines bc it creates explosive mixture)
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4
Q

what color is used for Nitrous and what color is used for O2?

A
  • Nitrous = blue (not fluted)

- Oxygen = green (fluted)

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5
Q

what are some of the advancements in flowmeters?

A
  • digital
  • increments of 0.1L
  • built in alarms for O2 depletion
  • emergency air intake valve
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6
Q

what are 3 available inhalation units?

A
  • accutron - NO2 lock
  • porter - automatic vaccum
  • matrix
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7
Q

Nitrous oxide/oxygen when used in combination with sedative agents may produce?

A
  • anxyiolysis
  • consious sedation
  • deep sedation / general anesthesia
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8
Q

how many people should be there to administer the Nitrous ?

A
  • at least one additional person should be present in addition to the dentist
  • this may be the chair-side dental assistant
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9
Q

when must an in-line oxygen analyzer be used?

A

if nitrous oxide and oxygen delivery equipment is capable of delivering less than 25% oxygen.

*the equipment must have an appropriate scavenging system

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10
Q

what must occur during administration?

A

-direct clinical observation of pt (do not leave the room)

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11
Q

what should be observed at all times while using nitrous/

A
  • color of mucosa, skin, or blood should be continually evealuated
  • oxygen saturation must be evaluated by pulse oximetry
  • must observe chest excursions
  • should auscultate breath sounds or monitor end-tidal CO2
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12
Q

what must happen during recovery and discharge?

A
  • oxgyen and suction equipment must be immediately available in the recovery area and/or operatory
  • must dertermine and document that oxygenation, ventilation, and circulation are stable prior to discharge
  • must provide explanation and documentation of postoperative instructions to the patient
  • dentist must determine that pt has met discharge criteria prior to leaving the office
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13
Q

what receptors is required by Nitrous for its action in caenorhabditis elegans

A

N-methyl-aspartate

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14
Q

what will prevent uptake of nitrous?

A
  • nasal obstruction
  • sinus problems
  • mouth breathing

*may not be adequate for extremely anxious pt

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15
Q

what occurs in the pretreatment visit?

A
  • explain technique
  • consider trial administration
  • preoperative instructions
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16
Q

what are the reoperative instructions to give your pt using nitrous?

A
  • take preop meds if extremely anxious
  • avoid heavy meals 4 hrs prior to treatment
  • escort requirement if indicated
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17
Q

how do you monitor the pt during the procedure?

A
  • preoperative vital signs

- verbal communication and periodic vitals

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18
Q

how should you prepare the equipment for use?

A
  • open cylinders slowly

- inspect unit for cleanliness and leakage

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19
Q

how should you prep the pt before the nitrous?

A
  • suggest restroom
  • review med hx and record vitals
  • baseline Trieger test
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20
Q

what are the 4 basic principles of administration?

A
  • always 100% O2 pre-op before placing hood
  • always 100% O2 post-op for 3-5 minutes
  • titrate N2O to optimal effect
  • always have 2nd adult present
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21
Q

what is the technique for administering N2O?

A
  • position patient supine
  • place unit behind patient’s head
  • start O2 flow 5-8 liters/minute
  • place and secure nasal hood
  • observe reservoir bag
  • begin to titrate N2O
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22
Q

what are the two techniques for titration of N2O?

A
  • constant liter flow (recommended)
  • constant O2 flow

*initial 20% N2O (approx 1L of 6L total)

23
Q

what is the technique for constant liter flow?

A
  • establish liter flow rate with 100% O2
  • inc N2O to 1L/min, while dec O2 by 1L/min
  • titrate by inc N2O by 0.5L/min and dec O2 by 0.5L/min
24
Q

what are the adv to constant liter flow?

A
  • smaller volume of gas
  • less cost
  • dec trace gases
25
Q

what are the disadv to constant liter flow?

A

-easier to oversedate (with fixed increments)

26
Q

what is the technique for constant O2 flow?

A
  • establish O2 flow
  • inc N2O by 1L/min (O2 constant)
  • titrate by inc N2O at 1L/min
27
Q

what are the adv of constant O2 flow?

A
  • easy

- large volumes (breathing adequacy)

28
Q

what are the disadv to constant O2 flow?

A
  • more costly

- more trace gases

29
Q

what is the ideal sedation with N2O?

A

-70% of pts at 30-40% N2O

  • 12% required less than 30%N2O
  • 18% required more than 40%N2O
30
Q

what are the signs of oversedation?

A
  • mouth closing
  • mouth breathing
  • nausea/ discomfort
  • inappropriate responses
  • dreaming
  • uncooperative
  • crying or laughing
  • lack of muscular coordination
31
Q

what three things do you do before discharging the patient?

A
  • question the pt
  • vitals
  • motor coordination test (Triger test)
32
Q

how common is excessive perspiration?

A
  • 2-3% incidence
  • peripheral vasodilation
  • treatment is to dec N2O
33
Q

when should you consider syncope?

A
  • if pallor, dec BP, and inc HR

* give 100% O2

34
Q

what is the most common cause of nausea?

A
  • oversedation (more than 50%)

* also caused by long procedures, anxious pts, inherent tendency, full stomach

35
Q

what is the tx for nausea?

A

dec N2O

36
Q

what are the complications with vomitting?

A
  • potentially serious, aspiration pneumonia, obstruction
  • pediatric more often than adult
  • early recognition of nausea is key to prevention
37
Q

what is the management for vomitting?

A
  • 100% O2
  • remove dental instruments and rubber dam
  • turn head to the side
  • emesis basin (high volume suction)
  • replace nasal hood (100% O2)
38
Q

is shivering common?

A

not common but if it does happen it would be at the end of a procedure

*tx with reassurance and a blanket

39
Q

where are the sources of contamination with the normal gas flow?

A
  • exhaling valve

- nasal hood

40
Q

where are the sources of contamination with the patient

A
  • talking
  • laughing
  • mouth breathing
41
Q

where are the sources of contamination with the equipment?

A

-defective valves and fittings

42
Q

where are the sources of contamination with the air conditioning?

A

recirculation

43
Q

what are the four factors affecting trace gas concentrations

A
  • frequency of use
  • operatory size
  • operatory ventilation
  • open v closed operatory
44
Q

what are the different ways to detect trace N2O?

A
  • inspection of rubber goods
  • soapy water test
  • professional service company
  • infared analyzer
45
Q

what is the ADA recommended concetration of N2O?

A

50 ppm

*within 6 inches of a dentist’s nose

46
Q

what is the ppm for scavenging hoods?

A

31ppm +/- 4.8ppm

47
Q

what things concerning N2O does the ADA recomend?

A
  • scavenging nasal hood
  • venting of suction outside
  • minimize patient talking
  • test equipment for leaks
  • air monitoring program (50ppm or less)
48
Q

what have animal studies shown as far as nitrous chronic exposure?

A

damage to brain cells and bone marrow suppression

49
Q

what are human reports of the chronic exposure to nitrous?

A
  • peripheral neuropathy

- long/term high dose abuse (greatest risk)

50
Q

who does the sexual phenomena of nitrous affect more?

A

females

  • always have an assistant present
  • avoid concentrations greater than 50%
51
Q

what are the legal considerations with nitrous?

A
  • never leave a pt unattended
  • get signed parent consent for children
  • monitor vitals
  • document vitals, %N2O, administration times, 3-5 min of 100% O2, and trieger test
52
Q

what is the N2O cylinder properties?

A
  • gas AND liquid
  • blue
  • 750 psi
  • 1590 L
53
Q

what is the O2 cylinder properties?

A
  • gas ONLY
  • green
  • 2000 psi
  • 625 L

Peds 2 (9 decks)

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