Equimolar Nitrous Oxide/Oxygen Versus Placebo for Procedural Pain in Children: A Randomized Trial

Reinoso-Barbero, Francisco; Pascual, Pascual; Lucas, R. de; García, Santos; Billoët, C.; Dequenne, Violaine; Onody, Peter

doi:10.1542/peds.2010-1142

Cited by 31 publications

(12 citation statements)

References 25 publications

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“…In concordance with the overall impression that equimolar nitrous oxide (N 2 O) and oxygen display an age-dependent effectiveness with only limited analgo-sedation in the first year of life compared to children of 4 years or older [165], a recently reported RCT documented that this inhalational strategy does not produce any additional pain relief during eye screening examinations in preterm neonates [166]. The mean PIPP score at speculum insertion in the control group (8.4, 95 % CI 7.6-9.3) was comparable with the nitrous oxide-exposed group (8.5, 95 % CI 7.3-9.8).…”

Section: Inhalational Agentssupporting

confidence: 67%

Sedation in the Neonatal Intensive Care Unit: International Practice

Allegaert

Anker

2014

Pediatric Sedation Outside of the Operating Room

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Inadequate pain management in neonatal life impairs neurodevelopmental outcome because it alters pain thresholds, pain-or stress-related behavior, and physiological responses later in life. However, there are recently also emerging animal experimental and human epidemiological data on the impact of analgo-sedatives on neuro-apoptosis and impaired neurodevelopmental outcome. As a consequence, the management of neonatal pain is in search of a new balance, and these conflicting observations are the main drivers to tailor our pain management in neonates. Adequate pain management is based on prevention, assessment, and treatment with subsequent reassessment. Issues related to prevention and assessment tools are covered. Non-pharmacological (e.g., complementary interventions like facilitated tucking, nonnutritive sucking) and pharmacological (e.g., acetaminophen, opioids, ketamine, propofol) treatment modalities were reviewed and reflect the increased knowledge on neonatal pain management. Each topic ends with some take-home messages that in part also reflect our opinion on the current status of this topic.

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Section: Inhalational Agentssupporting

confidence: 67%

Sedation in the Neonatal Intensive Care Unit: International Practice

Allegaert

Anker

2014

Pediatric Sedation Outside of the Operating Room

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“…For pain related to catheterization, despite a high information-delivery rate, preventive treatment delivery was only 27%, which could reflect the unsatisfactory analgesic protocols in the literature (Bruce et al, 2006). The treatment is efficient and well tolerated even in fragile populations as children or older adults and terminally ill patients (Annequin et al, 2000;Nicolas and Lassauzay, 2009;Reinoso-Barbero et al, 2011) or in the pre-hospital setting in acute trauma in adults (Ducassé et al, 2013). The 50% mixture of nitrous oxide and oxygen is not sufficiently well known or used for CRP relief, although indications and protocols are well established for many procedures such as changing dressings, haematological painful procedures, urodynamic procedures, colonoscopy and minor surgery (Annequin et al, 2000;Calleary et al, 2007;Aboumarzouk et al, 2011;Young et al, 2012;Yuxiang et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

Care‐related pain in hospitalized patients: Severity and patient perception of management

Ambrogi

Montcel

Collin

et al. 2015

European Journal of Pain

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“…In our experience, procedures could be achieved in all but one patient under Kalinox whereas 18.9% of the patients in the opioid analgesia required additional administration of opioids. The Kalinox side effect profile was evaluated versus placebo in a previous study in children [ 16 ]. A similar side effect profile in both groups was found with only two patients under Kalinox who reported dizziness requiring treatment withdrawal.…”

Section: Discussionmentioning

confidence: 99%

Impact of Opioid Analgesia and Inhalation Sedation Kalinox on Pain and Radial Artery Spasm during Transradial Coronary Angiography

Birgy

Trimaille

Messas

et al. 2020

JCM

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With respect to the transfemoral approach, transradial procedures enable a drastic reduction of bleeding events and are associated with a reduction of mortality. Radial artery spasm (RAS) is one of the most common complications and may lead to patient discomfort and procedural failure. Currently, there is no consensus on the optimal sedation protocol to avoid RAS. The aim of this study was to investigate the respective impact of opioids analgesia and inhalation sedation with a 50% nitrous oxide/oxygen premix (Kalinox) on pain and occurrence of RAS during transradial coronary procedures. Consecutive patients undergoing transradial coronary angiography were prospectively enrolled in one, single center observational study (Nouvel Hôpital Civil, Strasbourg, France). Patients received opioids analgesia or inhalation sedation with Kalinox. The primary endpoints of the study were the incidence of a pain scale ≥5/10 and the occurrence of RAS. The secondary endpoints were the incidence of side effects. A total of 325 patients were enrolled (185 in the opioids analgesia group, 140 in the Kalinox group). RAS and pain scale ≥5 rates were not significantly different in the opioids analgesia and Kalinox groups (respectively 13.5% vs. 10.0% and 16.2% vs. 11.4%). Headache was more frequently observed in the Kalinox group (6.4% vs. 0.0%; p = 0.002). By multivariate analysis, female gender, BMI <25 kg/m2, puncture difficulty, the use of plastic needle and 6F sheath were identified as independent predictors of RAS. Procedural inhalation sedation by Kalinox is as safe as opioids analgesia during transradial coronary angiography.

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Equimolar Nitrous Oxide/Oxygen Versus Placebo for Procedural Pain in Children: A Randomized Trial

Abstract: EMONO inhalation was well tolerated and had an estimated analgesic potency of 50%, and it is therefore suitable for minor pediatric procedures.

Cited by 31 publications

References 25 publications

Sedation in the Neonatal Intensive Care Unit: International Practice

Sedation in the Neonatal Intensive Care Unit: International Practice

Care‐related pain in hospitalized patients: Severity and patient perception of management

Impact of Opioid Analgesia and Inhalation Sedation Kalinox on Pain and Radial Artery Spasm during Transradial Coronary Angiography

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