Nitrous Oxide for Conscious Sedation

keaston · Dec 27, 2000

I have used nitrus for concious sedation in the rural setting. We used it for shoulder dislocatings and knee dislocations. Because of the area we didn't always have a doctor available and so we could use the nitrus without them. There was no written protocol just the delivery directly from the tank via mouth piece and demand regulator. The department didn't feel it was nessecary to vent the area as not mush is released into the air and it rapidly dispurses anyway.

jackcrna · Feb 11, 2001

Short term exposure to N2O (Nirous Oxide) is generally a safe proposition in most individuals however OSHA has specific guidelines for it's safe use. While I don't know what the laws and regulations are in Canada, OSHA is very specific about the need for scavenging equipment to remove N2O from the environement during use. The maximum allowable concentration in the room air during the administration of N2O is 25 PPM.

While N2O is one of the safest drugs used for sedation, analgesia, and anesthesia, it does have contraindications for it's use and it can have significant side effects with chronic exposure. It must be mixed with oxygen since 100% N2O causes hypoxemia/hypoxia. The maximum recommended concentration during anesthesia is 30%. Nitrous oxide diffuses into air containing cavities in the body. It should not be administred to individuals with bowel obstruction or free air in the cranium (possible with skull fractures or post pneumoencephalogram), pneumothorax and post tympanoplasty. Long term exposure can lead to bone marrow suppression with decreased production of WBC's. Pulse oximetry is strongly recommended as well as in line oxygen monitoring to prevent hypoxia. Contact OSHA in your state for a copy of their guidelines for the use of N2O. Additional guidelines and information can be found on the following links:

http://gasbone.herston.uq.edu.au/teach/su602/docs/e27_0ent.html

http://gasnet.med.yale.edu/societies/apsf/newsletter/1992/fall/index.html#art5

Jack

Conscious Sedation Cliical Competencies http://www.jackstem.com/cs_competencies.htm

I have used nitrus for concious sedation in the rural setting. We used it for shoulder dislocatings and knee dislocations. Because of the area we didn't always have a doctor available and so we could use the nitrus without them. There was no written protocol just the delivery directly from the tank via mouth piece and demand regulator. The department didn't feel it was nessecary to vent the area as not mush is released into the air and it rapidly dispurses anyway.
Originally posted by traumadrama:
Is anyone using Nitrous Oxide for Conscious Sedation in the ED? If so, what machine are you using, and how are you handling trapping of fumes/exhaled gases? If you have a protocol for its use, can you tell me a little about it? Thank you so much!
[This message has been edited by jackcrna (edited February 11, 2001).]

Cathy RN · Feb 16, 2001

Nitrous is used in ER to help with pain relief. I do not see a really good sedation with this and have not seen it used for conscious sedation only pain control. It is administered to patients through a mask or T-piece.To prevent over sedation, and as a safety precaution, only the patient holds the mask/t-piece. This prevents oversedation as the patient becomes sedated he will weaken his grip and either the seal will be broken or the mask etc will fall to the side. Again I have never seen a patient overdose on this.Unfortunately I wasn't aware of the air concentrations levels. I'll read more thanks for posting.