Purposes of Nitrous Oxide Sedation

1) Reduce fear, apprehension, and anxiety

2) Raise pain reaction threshold
3) Reduce fatigue
Minimum Alveolar Concentration
-concentration of drug required to produce immobility in 50% of pts
-is measure of potency
-minimum alveolar concentration of nitrous oxide is 105%
Four Plateaus of Stage I Anesthesia (Analgesia)
1) Paresthesia: tingling of hands and feet
2) Vasomotor: warm sensations
3) Drift: pupils centrally fixed and sensation of floating
4) Dream: eyes closed but will open in response to questions; difficulty speaking; jaw sags open
Preparation of Pediatric Patient for Nitrous Sedation
1) Place pt in reclined position
2) Use tell-show-do
3) Describe sensations in advance
Nitrous Oxide Technique Basics
1) Bag is filled w/ oxygen and hood placed on pts nose
2) Total flow rate is 4-6 L/min for most children
3) Percentage of NO is increased in 10% increments until drift plateau is achieved
4) Maintenance dose during operative procedure is about 30% NO
-must use no less than 20% oxygen
5) Most common complication of NO is nausea/vomiting, which occurs from excessive concentration of NO or
excessively long procedure
-NO levels should be reduced periodically throughout procedure, especially after 30 mins time
6) Give 100% oxygen for 3-5 mins after sedation period
Signs of Saturation
1) Continuously reminding child to keep mouth open
2) No response to questions
3) Agitation
4) Sweating
5) Nausea
6) Unconsciousness
Diffusion Hypoxia
-when NO is discontinued, there is a high outpouring of NO from tissues into lung, which dilutes available oxygen
in lungs
-can be prevented by giving 100% oxygen for 3-5 minutes following nitrous oxide procedure
Oral Sedation w/ Chloral Hydrate
-acts on CNS to induce sleep
-will not affect breathing, BP, or reflexes
-dose: 25-100 mg/kg (max single dose is 1 g)
-contraindicated in hepatic or renal impaired pts
General Anesthesia for Pedo
-age and maturity used to determine type of anesthesia for children
-very young children (below age in which they can reason) are indicated for general anesthesia
-most common premedication before GA is Versed