Nitrous Oxide-Oxygen Inhalational Sedation: Managing Pain and Anxiety, 2nd edition

Course overview

As many as three-quarters of adults experience dental fear ranging from mild to severe, and up to 10% are so terrified of dental treatment, they avoid any dental care. Anesthesia and sedation services for dental outpatients are commonly indicated for the management of fear, anxiety, and phobia, but whether dentists provide the various forms of sedation depends on their education, insurance costs, competency, equipment, and state regulations. Adults, in general, have few objections to taking medications by mouth or via inhalation, and the majority of fearful patients can be easily and safely treated by either of these routes, which are widely accepted, simple, convenient, painless, and inexpensive. The use of nitrous oxide-oxygen inhalational sedation to produce minimal sedation in order to reduce anxiety in healthy adults is typically safe and effective and is rapidly reversible, as the drug is quickly eliminated from the body. The use of nitrous oxide-oxygen inhalational sedation (N2O/O2 sedation) to relieve anxiety and pain may be considered one of the greatest achievements in dentistry, on a par with the invention and development of local anesthetics and the fluoridation of water. Although the specific technique of N2O/O2 sedation has changed considerably in the past 150 years, it continues to be the most versatile inhalational agent used of all general anesthetic agents and is important in both dental and medical practice. Initial concerns surrounding the hypoxic technique in which nitrous oxide was originally administered alone have been negated with the addition of equipment safety features and the coupling of the delivery of this gas with oxygen. In fact, the term nitrous oxide sedation is a misnomer and is more properly stated as nitrous oxide-oxygen inhalational sedation, since these two gases must now be given in combination. Indeed, one of the most important safety features required by all manufacturers of nitrous oxide machines is the assurance that, during administration to patients, nitrous oxide concentrations never exceed 70% (700,000 ppm). In other words, patients will always be receiving at least 30% oxygen (9% more than is available in ambient air). Upon completing this intermediate-level course, the learner will be able to discuss the continuum of consciousness and understand where N2O/O2 sedation may fit in the treatment paradigm. This course will also fill gaps in knowledge concerning patient selection, regulations, contraindications, and techniques for appropriate administration in certain special populations requiring advanced consideration. The principles learned will be directly applicable in determining the most suitable approach for the cardiac, pregnant, and breast-feeding patient, and will help to address staff concerns around potential environmental risks.