Nitrous Oxide – the Ideal Agent for Medical Office Procedures
If one were to create a list of the desirable attributes for an ideal agent to use in minimally invasive medical office procedures, nitrous oxide would check every box on that list.
At concentrations used clinically (i.e. less than 50%), nitrous oxide provides analgesia, anxiety relief, and amnesia with no respiratory depression, no effect on protective airway reflexes, and no loss of consciousness. Nitrous is safe to use by non anesthesia personnel, is of extremely short duration of action, and can be self-administered by patients S.A.N.O. The duration of action is so short that patients can drive themselves home soon after a nitrous-aided procedure.
To match the combined benefits of nitrous, a mixture of more than one class of drugs ( opioid + benzodiazepines) would otherwise be required. These combined medications however, would result in a deeper level of sedation and possibly delay discharge from the office because of synergism (combined effect greater than the sum of their separate effects. ). Also, there is always concern regarding the risk of loss of balance leading to falls following discharge when patients are given the mixed medications because the effects are so long-lasting.
Benzodiazepines also are included on the list of medications that the American Geriatric Society Beers Criteria recommends avoiding in patients 65 or older because of their effects on cognition.
Overall nitrous oxide provides all the desired effects while being safer and of shorter duration than any other agent available and its’ safety has been confirmed by many decades of use in dentistry and anesthesia.
Ramsey Nashed, MD
