Nitrous Oxide Inhalation Sedation (NOIS) – Conscious Sedation

We at Pushpagiri College of Dental Sciences, Thiruvalla, have newly introduced Nitrous Oxide Inhalation Sedation Unit (NOIS) for conscious sedation. Nitrous Oxide, also known as “laughing gas,” or “happy gas” is a safe and effective conscious sedation technique for both adults and children to help patients feel relaxed, relieve dental anxiety, and help make certain dental procedures easy and stress-free for patients.

Discussed in detail under the headings:

• Overview
• Objectives
• Indications
• Contraindications
• Mandatory instructions to the patients
• Instructions to the doctors

• Equipment
• Complications
• Conclusion
• Photographs

Overview:

It was first discovered in 1793 by the English scientist Joseph Priestly and has been used for more than 150 years. It has remained one of the most widely used anesthetics in both dental and medical applications.

Nitrous oxide is small inorganic chemical molecule and may also be known as dinitrogen oxide or dinitrogen monoxide. It is a colorless and nonflammable gas with a slightly sweet odor

Objectives:

• Reduce or eliminate anxiety
• Reduce untoward movement and reaction to dental treatment
• Enhance communication and patient cooperation.
• Raise the pain reaction threshold.
• Increase tolerance for longer appointments
• Aid in treatment of the mentally/physically disabled or medically compromised patient.
• Reduce gagging.
• Potentiate the effect of sedatives

Indications:

• A fearful, anxious, or obstreperous patient.
• Certain patients with special health care needs.
• Patient whose gag reflex interferes with dental care.
• Patient for whom profound local anesthesia cannot be obtained.
• A cooperative child undergoing a lengthy dental procedure.

Contraindications:

• Some chronic obstructive pulmonary diseases.
• Current upper respiratory tract infections.
• Recent middle ear disturbance/surgery.
• Severe emotional disturbances or drug-related dependencies.
• First trimester of pregnancy.
• Treatment with bleomycin sulfate.
• Methylenetetrahydrofolate reductase deficiency.
• Cobalamin (vitamin B12) deficiency.

Instructions to the patients:

(Before the procedure)

• Discuss about your past and present medical conditions and medications and verify if you are a potential patient for the procedure.
• Arrange to have someone accompany you at the end of your appointment.
• Wear comfortable clothing.
• Contact us prior to the appointment if there has been a change in your general health (severe cold, cough, fever etc.)
• It is advisable not to consume anything 3-4 hrs prior to the procedure.
• No alcoholic beverages before the procedure.
• Visit the washroom just prior to being seated for the procedure

(After the procedure)

• Follow all the instructions given to you by the dentist.
• Do not drive or operate machinery for immediately after the procedure.
• Take adequate rest after the procedure.
• In case you experience any problems, you must contact the dentist in charge.

Instructions to the doctors:

• Patient and parent consent
• Review of the patient’s medical history prior to the decision to use nitrous oxide.

This assessment should include:

• Allergies and previous allergic or adverse drug reactions.
• Current medications including dose, time, route, and site of administration.
• Diseases, disorders, or physical abnormalities and pregnancy status.
• Previous hospitalization to include the date and purpose.
• Recent illnesses (e.g., cold or congestion) that may compromise the airway

Disadvantages:

• Lack of potency
• Dependant largely on psychological reassurance.
• Interference of the nasal hood with injection to anterior maxillary region.
• Patient must be able to breathe through the nose.
• Nitrous oxide pollution and potential occupational exposure health hazards

Equipment:

The equipment delivering nitrous oxide/ oxygen is regularly checked for proper gas delivery and fail-safe function prior to use. Inhalation equipment has a capacity for delivering 100 percent, and never less than 30 percent, oxygen concentration at a flow rate appropriate to the patient size. The inhalation equipment also has a fail-safe system that is checked and calibrated regularly according to the practitioner’s state laws and regulations.

Only well trained and authorised professionals are permitted to use the unit.

Conclusion:

Nitrous oxide has significant medical uses, especially in surgery and dentistry, for its anaesthetic and pain reducing effects. It is on the World Health Organisation’s List of Essential Medicines, the safest and most effective medicines needed in a health system.

We at Pushpagiri College of Dental Sciences aim at delivering the most advanced and comfortable treatment options to our patients.