Quote from miss81
We already use nitrous oxide in our L&D dept, but I guess you would be the right person to ask about this considering where you work! Do you know where I can find any resources to use for creating a training module for RN's to use N20 for minor procedures in the ER? We do not titrate the percentage on L&D so our current training module does not discuss this. We would like to be able to titrate the percentage in the ER.
As for studies/articles r/t N2O and altitude, I found a few on pubmed but they were all very old (we're talking 80's). I did find one study that did discuss N2O and altitude, albeit only a little and I'm sure consider your job you already know this but I'll share anyway. This is not really significant to my practice as we are very close to sea level:
Nitrous oxide : The potency of anaesthetic gases is
proportional to their partial pressure and not the
percentage in mixture of oxygen is important. As
barometric pressure is reduced, fixed concentration
of inhaled anaesthetics will have less potency at
HA. So at HA above 3000 mtrs. There is significant
reduction of efficacy of 50% nitrous oxide in
reducing pain threshold9. Nitrous oxide has got
minimum alveolar concentration over 100% at sea
level. Since at HA, atleast 50% oxygen is to be
given in inspired gas as inhalation mixtures, so it is
of little use as an anaesthetic at 1500 mtrs and of no
value above 3000 mtrs due to its reduced
Children's Hospital of MN has developed a tremendous nitrous oxide sedation program - the most organized that I have seen so far. They have put together a "Toolkit" that they share with others to help guide with setting up your own program. They have been very open to helping others learn from their mistakes - as well as avoiding "re-creating the wheel". Here is a link to their website:
Childrens of MN is also developing a training program that other hospitals can send people to - but I think this is down the road a bit. Unfortunately there are not a lot of sources for nitrous oxide education in the U.S. - with the exception of dental schools. I think with more hospitals getting interested in nitrous oxide this will increase the demand for education.
I think the ability to titrate is very important - and allows you to adjust the percentages to "get" your patients to a level of sedation that they (and you) are comfortable with. 50% fixed is good for some and potentially too much or to little for others. From what I have heard the most common procedures being done where N20 is being used include: catheter insertion, sutures, IV start, gastrostomy, joint injections, PICC lines, and CT scans.
I appreciate you sharing the article on altitude, and can imagine at extreme altitudes it is a challenge to sedate patients. The article references 3000 meters (9,000 feet). The previous post mentioned 4000 feet and I know there are many in Denver that use nitrous oxide effectively!