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Local Anesthesia- Nitrous Oxide Part 2

STUDY
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Main Division
Demand Flow Unit
Continous flow unit
Portable
Central
Regulators
Reduce pressure from 750-2200 psi to a safe 45-55 psi
Manifolds
central system only
Automatic / non-automatic
Tubing
Outlet
Reservoir Bag
Conducting Tubes
Terminal Apparatus
Terminal apparatus
Nasal Cannula
Nasal Hood
Full Face Mask
Scavenging Nasal Hood
Flowmeter
individual gas calibration
Display gas in motion (+ 2%)
Oxygen flowmeter
green and fluted
N2O flowmeter
blue and non-fluted
Flowmeter advancing
Digital
Increments of 0.1L
Built in alarms for all gases
Emergency Air Intake Valve
Non-silenceable alarm
O2 depletion
Minimum O2 Flow
2 L/min
2% - 30%
DISS
Diameter Index Safety System
Different diameter and different thread
N2O is larger than O2
PISS
Pin Index Safety System
Safety Features
Emergency Air Inlet
Alarm
O2 Flush Button
Reservoir Bag
Color Coding
Quick-Connect Positive Pressure O2
Fail-safe
shuts off N2O if O2 flow is interrupted
Scavenging
Protects staff from excess N2O
Patient
conscious and participates in treatment
Patient benefits of N20
N2O-O2 easily tolerated by most patients
Treatment of choice for patients of all ages
Less fearful patient reduces staff stress
Patient comfortably participates in treatment
Patient apprehension and discomfort minimized
Opportunity to establish caring patient relationships
Post-treatment escorts and restrictions are minimized
Patient vital sign checks are the only monitoring necessary
Relaxed patient allows clinician to be more efficient
Administration considerations
Patients response
nasal obstruction
mouth breathing
extremely anxious patients
Mouth breathing
prevents uptake
Pretreatment
Explain technique
Consider trial administration
Preoperative instructions
Pre-op medication - escort requirement
Avoid heavy meals 4 hours prior to treatment
Monitoring
Preoperative vital signs
Verbal communication and periodic vital signs
Optional - pulse oximeter, EKG, precordial stethoscope
Preperation of equipment
Open cylinder slowly
Inspect unit for cleanliness and leakage
Preperation of patient
Suggest restroom
Review medical history and record vital signs
Baseline Trieger Test
O2 Technique
Medical History evaluation
Position patient supine
Position unit behind patient's head
Start O2 flow at 5 - 8 L/min
Place and secure nasal hood
Determine flow rate - preoxygenate
Observe reservoir bag for inflation
Patient positioning
Supine
Unit positioning
behind patients head
O2 flow
5-8 L/min
N2O technique
Start N2O at 15% for one minute
Suggest patient may start feeling effects; remind patient to breathe deeply
Increase by 5% every minute until patient feels optimal effect
Average patient reaches appropriate sedation between 25% and 45%
Explain possible symptoms: warmth, relaxation, paresthesia
N2O start
15% for 1 min.
may begin to feel effects
breathe deeply
N2O increase
5% every minute until optimal
Average sedation percentage
25%-45%
symptoms: warmth, relaxation, paresthesia
50% N2O without symptoms
check mouth breathing, shallow breathing, loose mask, kinking of tubing
3 deep breaths and adjust accordingly
Maximum N20
70%
Always...
have 2nd adult present
Post treatment oxygen
100%
3-5 mins.
Recovery
trieger test
vitals
Documentation
vitals, % N20, time, 3-5 mins. 100% O2, trieger test
Rapid Induction technique
Must know patient's usual percentage of N2O
Establish tidal volume from records
Administer 70% n2O at 10 L /min and have the patient take three deep breaths
Collapse the reservoir bag by hand to express all the contents
Administer usual N2o percentage and reduce flow to normal tidal volume for patient
Titration of N20
Constant liter flow
Constant O2 flow
Constant liter flow
Establish O2 flow rate with 100% O2
Increase N2O to 1L/min, while decreasing O2 by 1L/min
Titrate by increasing N2O by 0.5 L/min and decrease O2 by 0.5 L/min
Advantages of constant liter flow
Smaller volumes of gas
Less cost
Decreased trace gases
Disadvantages of constant liter flow
Easier to oversedate (with fixed increments)
Constant O2 Flow
Establish O2 flow
Increase N2O by 1 L/min
Titrate by increasing N2O at 1 L/min
N20 percentages ?
L/min N2O
% of N2O - _________________
L/min O2 + L/min N2O
OR _________________________
L/min N2O
% of N2O = ________________
Total flow in L/min
Advantages ofConstant O2 Flow Technique
Easy
Large volumes (breathing adequacy)
Disadvantages of Constant O2 Flow Technique
More costly
More trace gases
Technique of administration
Observe / evaluate patient
Continue titration (5-10%) increments
Observe / evaluate patient
Begin dental treatment, continue observation
Ideal Sedation
70% of patients at 30-40% N2O
12% required < 30% N2O
18% required > 40% N2O
Overdsedation
Mouth closing
Mouth breathing
Nausea / discomfort
Inappropriate responses
Incoherent / Dreaming
Uncooperative
Emotional (crying or laughing)
Lack of muscular coordination
Oversedation treatment
Immediately terminate flow of N2O
and give O2 for 3 -5 minutes
Post-treatment
Discharge of patient
Patient questioning
Vital signs (BP, P,R)
Motor coordination - Trieger Test
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