Continuous-flow delivery of nitrous oxide and oxygen: A safe and cost-effective technique for inhalation analgesia and sedation of pediatric patients.¹

Nitrous Oxide (N20) safely and rapidly alleviates the pain and distress of minor procedures in the emergency department (ED). We have found self-administration in children does not consistently achieve acceptable analgesia and sedation.

Level of Sedation with Nitrous Oxide for Pediatric Medical Procedures²

Nitrous oxide (N2O) delivered at a concentration <50% is accepted as a minimal sedation drug by both the American Society of Anesthesiologists and the American Academy of Pediatrics. The expected level of sedation at an N2O concentration >50% is less clear.

Safety of High-Concentration Nitrous Oxide by Nasal Mask for Pediatric Procedural Sedation³

Nitrous oxide is an effective sedative/analgesic for mildly to moderately painful pediatric procedures. This study evaluated the safety of nitrous oxide administered at high concentration (up to 70%) for procedural sedation.

Nitrous Oxide Reference List⁴

Nitrous oxide for pediatric medical procedural sedation

Case-Series of Nurse-Administered Nitrous Oxide for Urinary Catheterization in Children⁵

Children undergoing urologic imaging studies requiring urethral catheterization experience considerable discomfort and psychological distress. Nitrous oxide sedation may mitigate these detriments but the requirement for physician administration has limited the applicability of this technique.

Nurse-Driven Initiative Provides a more Realxed Experience for Patients and Families⁶

When trying to effect change in healthcare quality, whether on one unit or throughout an organization, it all starts with a culture conducive to transformation. It also helps if your nurse manager is a supportive proponent of evidence-based practice.

Nitrous oxide inhalation is a safe and effective way to facilitate procedures in paediatric outpatient departments⁷

To evaluate the efficacy and safety of nitrous oxide treatment given to children presenting procedural problems in a paediatric outpatient department.

Nitrous oxide–oxygen or oral midazolam for pediatric outpatient sedation⁸

A total of 1112 pediatric outpatient sedations, by either nitrous oxide–oxygen inhalation (N2O) or oral midazolam, administered over a 10-year period were reviewed. Patient responses and outcomes were evaluated to ascertain the safety of these sedation techniques.

Practice Guidelines for Sedation and Analgesia by non-Anesthesiologists⁹

Because Minimal Sedation (“Anxiolysis”) entails minimal risk, the guidelines specifically exclude it. Examples of Minimal Sedation include peripheral nerve blocks, local or topical anesthesia and either (1) less than 50% N2O in O2 with no other sedative or analgesic medications by any route, or (2) a single, oral sedative or analgesic medication administered in doses appropriate for the unsupervised treatment of insomnia, anxiety or pain.

Practice Guidelines for Moderate Procedural Sedation and Analgesia 2018¹⁰

These guidelines focus specifically on the administration of moderate sedation and analgesia for adults and children. The guidelines exclude patients who are not undergoing a diagnostic or therapeutic procedure (e.g., postoperative analgesia). Because minimal sedation (anxiolysis) may entail minimal risk, the guidelines specifically exclude it…