Pain & Anxiety

1. Chapter 3
Based on
Handbook of Nitrous Oxide & Oxygen Sedation, 3rd edition
Morris S. Clark
Ann L. Brunick
Nitrous Oxide & Oxygen Sedation

2.  Unpleasant sensory or
emotional experience
 Arising from actual or
potential tissue damage
 Perception and response
to stimulus

3.  Nociceptors receive
stimulus
 Occurrence, intensity,
duration & location of pain
 Opioid system – modifies
or alters pain impulses
 Analgesic concentrations
of Nitrous
 Act directly on the opioid
receptors
 Activate release of
endogenous opiates

4.  Reversed by oxygen replacing nitrous oxide
 Pain reaction influenced by these factors:
 Physical
 Mental
 Biochemical
 Psychogenic
 Social
 Physiologic
 Cultural
 Emotional

5.  Objectify level of pain to
allow appropriate care
 Zero to ten ( 0 - 10 )
 Facial images
 Numeric scales
 Extent of pain
 Understanding of pain

6.  Nonspecific feeling of
 Apprehension
 Worry
 Uneasiness
 Dread
 Fear
 May accompany
 Restlessness
 Tension
 Tachycardia
 dyspnea

7.  Feeling of fright or dread
 Related to identifiable
source
 Recognized by the
individual

8.  Persistent and irrational
fear
 Of something specific
 Object
 Activity
 Situation
 Results in avoidance or
desire to avoid stimulus
 Fear that is recognized as
excessive or unreasonable

9.  Are interrelated and
hard to separate
 Synergistic effect
between fear and pain
 When fear or pain is an
issue
 Both MUST be
managed

10.  Patients do not care what
providers know
 Until the know they CARE
 Empathy = eye contact
 Communication
 Concern and caring
 Compassion
 Modified Dental Anxiety
Scale
 Communicates fear &
anxiety

11.  Anxiolysis
 Drug induced state
 During which patient
responds normally to
verbal commands
 Cognitive functions &
coordination may be
impaired
 Respiration and CV
functions unaffected
 Nitrous oxide < 50%

12.  Drug induced
 Depression of
consciousness
 Patients respond
purposefully to verbal
commands
 May need stimulation to
respond
 No intervention is required
to maintain airway
 Spontaneous respiration
 CV function of normal
 Nitrous oxide > 50%

13.  Drug induced depression of consciousness
 Patient not easily aroused
 May respond purposefully after stimulation
 May require assistance to maintain airway
 Spontaneous respiration is inadequate
 CV usually normal

15.  Drug induced loss of
consciousness
 Patient is not arousable
 Must maintain airway
and ventilation
 CV functions may be
impaired

16.  Positive pressure
ventilation
 Ambu bag mask
 Nasotracheal tube
 Oropharyngeal tube

18.  Local anesthesia is
backbone for pain
management
 Oral Route
 IM Intramuscular
 Inhalation
 IV intravenous

20. You Must Be Prepared
For The Next Deeper Level … or More

21.  20 % nitrous = 15 mg.
MORPHINE
 20% Nitrous - 80%
Oxygen
 1 L/min nitrous to
4 L/ min oxygen
 1 L nitrous / 5 L oxygen
 20%

22.  Will raise patients pain threshold
 Nitrous will manage both fear and pain
 Will produce a sense of well-being
 Will manage MILD fear

23.  Amnesic
 cannot recall severity of pain, anxiety, or duration
 Time appears to be unclear and compressed
 Onset of Action
 Rapid - less than 30 seconds, peaks in < 5 minutes
 Titration
 Administer drug incrementally
 To specific level or treatment endpoint / target
 Allows for exact amount of drug needed to be delivered

24.  Recovery
 With 100% oxygen for
minimum of 5 minutes
 Recovery time may vary
 Elimination
 Rapidly eliminated from
body by respiratory
system
 Acceptance
 Patients accept nitrous
very well

26.  Soothing, calm, humor,
encouraging words
 Distraction
 Hypnosis
 Audioanalgesia – music
 Electronic dental
anesthesia
 Oral medication
 Local anesthesia