Nitrous oxide/oxygen is a commonly used inhalational sedative that provides mild to moderate sedation for patients undergoing dental and medical procedures.
Nitrous oxide/oxygen sedation, also known as "laughing gas", is a safe and effective method of conscious sedation that can be used for children, young people, and adults.
Nitrous oxide/oxygen works by suppressing the central nervous system and reducing the patient's perception of pain and anxiety.
The mechanism of action of nitrous oxide/oxygen is not fully understood, but it is believed to work by enhancing the activity of inhibitory neurotransmitters like GABA in the central nervous system. Nitrous oxide/oxygen has a high lipid solubility and can easily cross the blood-brain barrier, where it interacts with GABA receptors and other receptors in the CNS.
Nitrous oxide/oxygen has a biphasic effect on the central nervous system, meaning that it initially enhances neuronal activity, leading to a brief period of excitation, followed by a period of inhibition, resulting in sedation and analgesia.
Sedative
The sedative effect of nitrous oxide/oxygen is dose-dependent, with higher concentrations leading to deeper levels of sedation. At lower concentrations, nitrous oxide/oxygen can reduce anxiety and produce a sense of relaxation without causing loss of consciousness.
Analgesic
In addition to its sedative properties, nitrous oxide/oxygen has analgesic properties, which can help to reduce the patient's perception of pain during the procedure. This is thought to occur through the activation of endogenous opioid receptors in the brain, which results in the release of natural endorphins and other pain-relieving compounds.
The patient inhales a mixture of nitrous oxide and oxygen through a mask or nasal cannula, which is adjusted to deliver the desired level of sedation. The concentration of nitrous oxide is titrated to achieve the desired level of sedation, with typical concentrations ranging from 20% to 50%.
The maximum recommended concentration of nitrous oxide is determined by national regulations, and varies between the Europe countries from 50 to 70%. The commonly effective dosage for most children tends to be 30–40%.
What is its onset and recovery time?
One of the advantages of nitrous oxide/oxygen sedation is that it has a rapid onset and recovery time, allowing patients to return to their normal activities quickly after the procedure. It also has a wide safety margin and can be easily adjusted by the healthcare provider during the procedure.
As well as its sedative properties, nitrous oxide/oxygen has analgesic properties that can help to reduce pain and discomfort during the procedure. It is also useful in reducing patient anxiety, which can improve patient cooperation and reduce the risk of complications.
Key Points
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Nitrous oxide/oxygen, or "laughing gas," is a safe and effective sedative for children, young people, and adults.
It works by reducing pain and anxiety through the central nervous system, likely enhancing inhibitory neurotransmitters like GABA.
Rapid onset and recovery times allow patients to quickly return to normal activities post-procedure.
The sedative effect is dose-dependent, with analgesic properties reducing pain during procedures.
Typical concentrations range from 20% to 50%, with a maximum of 50–70% depending on national regulations.
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