what are the four main divisions of nitrous delivery systems?
- demand flow units
- continuous flow units (what we use in dentistry)
- portable
- central (more complex)
what is the biggest source of contamination for Nitrous?
talking
what do regulators do?
- reduce pressure from 750-2200 psi to a safe 45-55 psi
- only used with central systems
- uses grease (cannot use petroleum based products w O2 lines bc it creates explosive mixture)
what color is used for Nitrous and what color is used for O2?
- Nitrous = blue (not fluted)
- Oxygen = green (fluted)
what are some of the advancements in flowmeters?
- digital
- increments of 0.1L
- built in alarms for O2 depletion
- emergency air intake valve
what are 3 available inhalation units?
- accutron - NO2 lock
- porter - automatic vaccum
- matrix
Nitrous oxide/oxygen when used in combination with sedative agents may produce?
- anxyiolysis
- consious sedation
- deep sedation / general anesthesia
how many people should be there to administer the Nitrous ?
- at least one additional person should be present in addition to the dentist
- this may be the chair-side dental assistant
when must an in-line oxygen analyzer be used?
if nitrous oxide and oxygen delivery equipment is capable of delivering less than 25% oxygen.
*the equipment must have an appropriate scavenging system
what must occur during administration?
-direct clinical observation of pt (do not leave the room)
what should be observed at all times while using nitrous/
- color of mucosa, skin, or blood should be continually evealuated
- oxygen saturation must be evaluated by pulse oximetry
- must observe chest excursions
- should auscultate breath sounds or monitor end-tidal CO2
what must happen during recovery and discharge?
- oxgyen and suction equipment must be immediately available in the recovery area and/or operatory
- must dertermine and document that oxygenation, ventilation, and circulation are stable prior to discharge
- must provide explanation and documentation of postoperative instructions to the patient
- dentist must determine that pt has met discharge criteria prior to leaving the office
what receptors is required by Nitrous for its action in caenorhabditis elegans
N-methyl-aspartate
what will prevent uptake of nitrous?
- nasal obstruction
- sinus problems
- mouth breathing
*may not be adequate for extremely anxious pt
what occurs in the pretreatment visit?
- explain technique
- consider trial administration
- preoperative instructions
what are the reoperative instructions to give your pt using nitrous?
- take preop meds if extremely anxious
- avoid heavy meals 4 hrs prior to treatment
- escort requirement if indicated
how do you monitor the pt during the procedure?
- preoperative vital signs
- verbal communication and periodic vitals
how should you prepare the equipment for use?
- open cylinders slowly
- inspect unit for cleanliness and leakage
how should you prep the pt before the nitrous?
- suggest restroom
- review med hx and record vitals
- baseline Trieger test
what are the 4 basic principles of administration?
- always 100% O2 pre-op before placing hood
- always 100% O2 post-op for 3-5 minutes
- titrate N2O to optimal effect
- always have 2nd adult present
what is the technique for administering N2O?
- position patient supine
- place unit behind patient’s head
- start O2 flow 5-8 liters/minute
- place and secure nasal hood
- observe reservoir bag
- begin to titrate N2O
what are the two techniques for titration of N2O?
- constant liter flow (recommended)
- constant O2 flow
*initial 20% N2O (approx 1L of 6L total)
what is the technique for constant liter flow?
- establish liter flow rate with 100% O2
- inc N2O to 1L/min, while dec O2 by 1L/min
- titrate by inc N2O by 0.5L/min and dec O2 by 0.5L/min
what are the adv to constant liter flow?
- smaller volume of gas
- less cost
- dec trace gases
