5.3 Basic behavior guidance Techniques
Nitrous Oxide/Oxygen-Inhalation Sedation
Description:
Nitrous oxide/oxygen-inhalation sedation is a safe and effective technique in most cases to reduce anxiety and enhance effective communication. Its onset of action is rapid, the depth of sedation is easily titrated and reversible, and recovery is rapid and complete. Additionally, nitrous oxide mediates a variable degree of analgesia, amnesia, and gag reflex reduction.
The decision to use nitrous oxide must take the following factors into consideration: (1) alternative behavior guidance modalities, (2) the child’s oral health needs, (3) the effect on the quality of care, (4) the child’s emotional development, and (5) the child’s physical condition.
Objectives:
- Reduce or eliminate anxiety
- Reduce untoward movement and reaction to oral health procedures
- Enhance communication and the child’s cooperation
- Raise the pain reaction threshold
- Increase tolerance of long appointments
- Reduce gagging
Indications:
- A fearful, anxious, or obstreperous child
- A cognitively, physically, or medically compromised child
- A child whose gag reflex interferes with oral health care
- A child for whom profound local anesthesia cannot be obtained
Contraindications:
- A child with chronic obstructive pulmonary diseases
- A child with severe emotional disturbances or drug-related dependencies
- A child with sickle cell disease
- A child treated with bleomysin sulfate
Written informed consent must be obtained from a parent and must be documented in the child’s record before nitrous oxide is used. The child’s record should include (1) informed consent, (2) indication for use, and (3) nitrous oxide dosage (percent nitrous oxide/oxygen and/or flow rate, duration of the procedure, and post-treatment oxygenation procedure).
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