What effect does Nitrous Oxide have on the patient?
Nitrous Oxide primarily works as an anxiolytic and also has a mild analgesic effect, although an additional local anaesthetic may also be required for invasive procedures.
Patients describe a pleasant and relaxing effect, as well as a certain detachment from what is going on in the treatment room. Because of the analgesic effect, patients find the injection of the local anaesthetic less unpleasant and often barely notice as the needle is inserted. Gag reflex is usually suppressed.
What technical equipment is needed to use Nitrous Oxide sedation?
The basic equipment you will need is a flowmeter (mixer), a patient breathing circuit for the supply and removal of the gas mixture, nasal masks, and medical gases (Oxygen and Nitrous Oxide), supplied to the flowmeter via pressure hoses either from gas cylinders on a mobile trolley, or from a centrally gas piped system from the gas cylinder location elsewhere in the practice.
We recommend also have a pulse oximeter for optimum patient monitoring, which allows you to keep an eye on the patient’s pulse and oxygen saturation quickly and easily. It is recommended that all practices have emergency equipment.
How safe is Nitrous Oxide Conscious Sedation?
Nitrous Oxide sedation is an extremely safe method, used by millions worldwide. It is standard practice in many places, including Australia, the United States and Scandinavia.
The high-quality equipment from Accutron Inc. has a Nitrous Oxide cut-off, meaning that a maximum of 70% nitrous oxide can be administered to the patient.
Nitrous Oxide is supplied in a percentage mixture and can therefore be optimally adjusted to the patient’s needs. As a result, an overdose is practically impossible. Nevertheless, there are certain factors which rule out the use of nitrous oxide, such as pneumothorax.
Completion of an certified training course for Nitrous Oxide Sedation is recommended.
What is the Bag on the Flowmeter unit for?
The Breathing Bag (or Reservoir bag) on the Sedation unit is for monitoring the patient’s respiratory volume compared to the total flow coming for the Flowmeter. In other words, it is indicating if the machine is set to provide enough gas flow to suit the patient’s breathing.
If the bag is empty, the gas flow rate from the flowmeter is set too low for the patient. If the bag is full the flow rate may be set to high, allowing you to reduce the total flow setting at the unit to compensate.
Ideally you want the bag to be approximately 1/2 to 2/3 full and constant. Remember that the respiratory rate of the patient will vary over the administration, especially at the onset of the Nitrous Oxide gas flow as the sedative effect starts.
How can payment for Nitrous Oxide sedation be settled?
The valuation standard for dental services in Australia, the Dental Board Schedule of Fees does cover nitrous oxide sedation in its catalogue of services. Whilst a value is listed within the Schedule of Fees, charges from individual practices do vary.
How quickly does Nitrous Oxide take effect and how long do its effects last?
Nitrous oxide inhalation sedation is the fastest available method of dental sedation; the onset and recovery times are just a few minutes each. Importantly the use of 100% Oxygen post administration will minimise recovery time to even shorter periods, and the 02 flush provides quick recovery in case of emergency.
Patients are usually able to leave the offices unaccompanied after 15 to 30 minutes and continue their everyday activities as normal.
What is the maximum amount of time treatment can last under N20 Sedation?
Nitrous Oxide sedation can conveniently be used to carry out even time-intensive treatments in an environment which is pleasant and comfortable for the patient.
There are no time limits or conditions imposed for safety or health reasons, but a break is recommended after four hours of treatment, not only for the sake of the patient but also for the dentist carrying out the treatment.
How do the gauges on the regulators for the gas cylinders work?
The Oxygen Regulator gauge works proportionally (like a car fuel gauge); that is, the gauge need will drop at the same level as the contents of the cylinder.
However, the Nitrous Oxide Regulator gauge works differently. Because the contents of the Nitrous Oxide are mostly liquid when in the cylinder, the gauge will not start to drop until the cylinder contents are about 70% empty (a good time to order a new cylinder from your gas supplier).
You may also note the gauge of the Nitrous Oxide cylinder is simpler in appearance, and has a line that the gauge needle normally sits above. If the needle is above the line the contents of the cylinder is greater than 30% full.
Condensation forms on the pressure regulators, is that normal?
This is normal because the canisters cool down under pressure, and in warm rooms the moisture in the air collects as condensation.
It occurs more on hot days in the summer, and also in winter when heating is used in the surgery.
Is Nitrous Oxide heavier than air?
Nitrous oxide is roughly one and a half times as heavy as air and collects along the ground. For this reason, good ventilation must be ensured during and after Nitrous Oxide sedation to enable the Nitrous Oxide to escape.
The concentration at the workstation can be kept at a very low level thanks to the integrated exhaust ventilation of a ARTG listed patient breathing circuit.
How do I know how much gas is in the cylinders?
The current level of oxygen in a canister can be calculated from the nominal volume and the current pressure: at a pressure of 200 bar and a nominal volume of 10 litres, the volume in the canister corresponds to 2,000 litres (200 bar x 10 litres). When the oxygen level reaches 500 litres (50 bar), we recommend that you order a new oxygen canister so that the practice can continue working without any interruption.
The current level of nitrous oxide in a canister can only be determined from the weight. However, it is not possible to constantly weigh the nitrous oxide canister during the normal day-to-day operation. As a rule of thumb, if the pressure in the canister drops below 50 bar, there is still enough nitrous oxide remaining for treatment lasting 30-45 minutes.
In light of the information above, it is advisable to keep a spare cylinder of Nitrous Oxide and cylinder of Oxygen on stock at all times as a precaution. This will enable you to guarantee the smooth running of procedures at the practice.
How should reusable nasal masks be cleaned?
The reusable nasal masks can be autoclaved at 134°C for 4 minutes.
Thermal disinfection for 10 minutes at 93°C is also acceptable.
We recommend cleaning the reusable nasal masks after every treatment by autoclaving them or cleaning them in a thermal disinfector. The nasal masks should be replaced when the material becomes porous.