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

Abstract

Aims: To evaluate the efficacy and safety of nitrous oxide treatment given to children presenting procedural problems in a paediatric outpatient department. Methods: The study comprised 70 children 6-18 years old. Two different groups were studied. (1) Children presenting with problems in establishing venous cannulation (VC) (n = 50). The patients were randomised to conventional treatment (CO); cutaneous application of EMLA or nitrous oxide treatment (NO); N 2 O and EMLA. (2) Anxious children/children undergoing painful procedures who repeatedly come to the clinic (n = 20). These children underwent two procedures with CO/NO, the order of priority being randomised. Altogether the study included 90 procedures. Main outcome measures were procedure time, number of attempts required to establish VC, pain, and evaluation. Results: All procedures were performed with NO while four VC (8%) were not possible to perform with CO. The number of attempts required to establish VC was lower when using NO (median 2, range 2-9), compared with CO (median 4, range 2-9). The estimated pain was lower with NO. The total mean time required was similar for NO and CO when the time required for the NO procedure was included. One complication, tinnitus, was observed; it disappeared within 3 minutes. Conclusion: The pretreatment with nitrous oxide is a time effective and safe method for use at paediatric outpatient departments to reduce pain, facilitate venous cannulation, and thereby reduce the number of costly cancellations of planned procedures. P ain, anxiety, and difficulties related to venipunctures (VP), venous cannulations (VC), and other procedures are recurrent problems in paediatric outpatient departments, resulting in trauma for the children and sometimes delayed and cancelled procedures.

Effects of Midazolam and Nitrous Oxide on Endocrine and Metabolic Measurements in Children

“…access in distressed children with chronic diseases or obesity [16,22]. This was confirmed in this study when the levels of stress hormones were correlated with the evaluation of the procedure.…”

“…However, we have previously found EMLA to be insufficient to obtain a satisfactory pain relief [16]. N 2 O and midazolam are also frequently used drugs to facilitate painful procedures [17,18].…”

Schmerzkonzept einer kinderchirurgischen Klinik

“…Lachgas wird im klinischen Alltag durch speziell geschultes Pflegepersonal und die Kinderchirurgen selbst appliziert [7][8][9][10]14]. Dieses Vorgehen wurde bereits 2009 durch den Berufsverband Deutscher Anästhesisten (BDA) und die Deutsche Gesellschaft für Anästhe-siologie und Intensivmedizin (DGAI) bestätigt [6].…”

“…Ein rascher Wirkungseintritt und ein schnelles Ende nach Unterbrechung der Applikation beobachteten alle Arbeitsgruppen [9]. Die von Ekbom et al [9] und Bar-Meir et al [4] empfohlene Inhalation von 100%igem Sauerstoff und eine intensive Überwachung nach der Lachgasapplikation [7,14] sind entsprechend unserer eigenen Daten nicht erforderlich.…”

Management of Dental Anxiety: Is There Scope Beyond Conscious Sedation?

“…[16] Treatment with nitrous oxide and oxygen is a well-established method for pain alleviation and has been used with good results particularly in children who fear the dentist. [17] The limited reported studies in literature regarding the comparison between these techniques prompted us to evaluate and compare the effectiveness of N2O/O2 inhalation sedation and video-eyeglass distraction in managing anxious children during dental extraction.…”