The document discusses nitrous oxide and oxygen sedation, including how nitrous oxide works in the body to reduce pain and anxiety by acting on opioid receptors or increasing endogenous opiates, with effects being reversed by oxygen. It also addresses levels of sedation from anxiolysis to general anesthesia, factors that influence pain response, and techniques for pain and anxiety management during dental procedures.

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