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OS 3 > N20 sedation > Flashcards

N20 sedation Flashcards

1
Q

Nitrous Oxide N2 O
* happy/sad?
* emotions/inhibitions of pt?

A
  • Nitrous Oxide a.k.a. laughing gas
  • Nitrous oxide does NOT make a person happy or sad
  • Decreases the inhibitions of the patient
  • Increases the intensity of emotions
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2
Q

Physical properties n2o

A
  • Only inorganic anesthetic gas in clinical use
  • Colorless and odorless
  • Capable of oxygen supporting combustion
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3
Q

n2o effects on pulmonary, cardio, and renal systems

A
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4
Q

Toxicity of n2o

A
  • Prolong exposure Bone marrow depression, Neurological deficiencies peripheral
    neuropathies and pernicious anemia
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5
Q

n2o production

A
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6
Q

Impurities of n20

A
  • N2 (nitrogen), NO (nitric oxide), NO2 (Nitrogen dioxide), NH 4 ammonia
    water vapor and CO (carbon monoxide)
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7
Q

most dangerous impurity of n2o

A

NO is most dangerous impurity
* Combine with Hg and prevent O 2 absorption and may also react with water vapor
to form acid = damage pulmonary epithelium = pulmonary edema
* NO is form when N2 O is heated above 450 0 C

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8
Q

n2o hydrous state

A

N20 is anhydrous

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9
Q

n2o Properties
* iritation, smell, color?
* CNS?
* Specific gravity?
* Wall of the cylinder maybe cold due to?

A

Properties
* Nonirritating, sweet-smelling, colorless gas
* ONLY nonorganic compound other than CO2 that has CNS depressant
properties
* Specific gravity if 1.53 vs air (1)
* Wall of the cylinder maybe cold due to heat needed for vaporization into
gaseous state

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10
Q

Solubility n2o

A
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11
Q

is n2o oxygen usable

A
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12
Q

n2o flammable/explosive

A
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13
Q

Potency of n2o
* compared to other anesthetic gases
* solubility compared to n2/o2

A

Potency
* Least potent of the anesthetic gases
* N2O is
* 35X more soluble in plasma than N2
* 100X more soluble in plasma than O2

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14
Q

cns depression with n2o+o2

A

N2O + O 2 = CNS depression
* Some patient may get delirium
* Very few people will get Stage III anesthesia ( surgical anesthesia)

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15
Q

Optimum concentration of N 2O for production of
analgesia while maintaining patient cooperation is?

A

Optimum concentration of N 2O for production of
analgesia while maintaining patient cooperation is
35%

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16
Q

n2o mixture similar to morphine?

A

20%:80% mixture N2O-O 2 = 10-15mg of morphine

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17
Q

special properties of n2o

A

concentration effect and second gas effect

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18
Q

Concentration Effect

A
  • The higher the concentration of the gas inhaled, the more rapidly arterial tension of the gas increases
  • Fresh gas will be pushed into the lungs from the anesthesia machine= increase arterial N 2 O arterial tension
  • So its important to start the Nitrous slowly and not blast it high in the beginning
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19
Q

2nd Gas Effect

A
  • Occurs when a second inhalation anesthetic is administered along with N 2O-O 2
  • Extreme uptake of N 2O will form a vacuum at alveoli that forces other air ( in this case, other inhalational agent) into the lungs
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20
Q

how does n2o inhalation work

A
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21
Q

mechanism of n2o

analgesic and anxiolytic

A
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22
Q

What happen when the N 2O session is over

A
  • N2O diffused out of the blood and into the alveoli as rapidly as it diffused into the blood during the induction
  • If patient simply breath room air and not O2  Patient may get diffusion hypoxia
  • Prevention: administer 100% O2 for 3-5 mins at the termination of the procedure
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23
Q

Diffusion Hypoxia

A
  • As the N2O is rushed out of the body, it will take other airs out including CO2
  • Lowering CO 2 tension in blood will cause respiratory depression
  • S/s: Headache, Nausea, Lethargy  hangover effect
24
Q

N2O at CNS

A
  • Actual mechanism of action is unknown
  • Almost all form of sensation are depressed.
  • Mild Depression on CNS at Cerebral cortex
  • Area postrema (vomiting center) of Medulla is not affected unless hypoxia or anoxia is present
25
Q

n2o at CV system

A
  • No clinically significant effect
  • Slight depression of myocardial contraction
  • Slight increase in vascular smooth muscle to norepinephrine
26
Q

n2oirritation at pulmonary system

A
  • Not irritating to pulmonary epithelium
  • Ok for Asthma
27
Q

n2o at GI

A

no effect

28
Q

n2o at renal

A

no efffect

29
Q

n2o and hematopoesis

A
  • Inhibits methionine synthetase> impair B12 metabolism > decreased Bone Marrow function = Pernicious anemia (Vitamin B12 anemia)
  • Long term exposure ( > 24 hr exposure) = transient bone marrow depression
30
Q

n2o and skeletal mm

A

Does not produce relaxation of skeletal muscle

31
Q

o2 properties

A
  • Clear colorless, odorless
  • Specific gravity of 1.105
32
Q

o2/n2o cylinders

colors/psi

A
33
Q

Advantages of Inhalational Sedation:
* Onset?
* recovery?
* N2O metab?
* Able to?
* No?
* side effects?
* ADRs?
* Nitrous Does have?

A
  • Onset of action is similar to IV sedation
  • Fast recovery (3-5 mins)
  • N2O is not metabolized by body
  • Able to Titrate ( administer small incremental dose until the desired clinical action is obtained)
  • No injection
  • Few side effect
  • No adverse reaction to body organ/ system
  • Nitrous Does have analgesic properties (20% n2o=10-15mg morphine)
34
Q

Disadvantages of n20 inhalation

A
35
Q

Contraindications to inhalation sedation

A
  • No absolute contraindication
  • Claustrophobic patients
  • Compulsive personality ( take charge)
  • Children with severe behavior problems
  • Upper respiratory tract infection
  • COPD ( chronic bronchitis, Emphysema)
  • Pregnancy
36
Q

Indications of inhalation sedation

A
37
Q

Armamentarium for inhalation sedation

A
38
Q

Compressed-gas cylinders safety and psi

A
  • Cylinder are designed to handle 1.66 times the usual pressure
  • Example: Usual 2000 psi O 2 cylinder is designed to hold up to 3400 psi
39
Q

Handling of cylinders
* Never use?
* Storage position?
* drop?
* temps to avoid?
* valves?
* “cracking”

A
  • Never use grease, oil or lubricant
  • Store in vertical position
  • Don’t drop them
  • Avoid heat and fluctuating temperature
  • Close all valves tightly even when its “empty”
  • “Cracked” cylinder before use= Let some gas out before connecting to the system
40
Q

Cylinder sizes

A
  • From a small A size to large HH size
  • Portable Nitrous oxide unit uses “E cylinder for both Oxygen and N2O
41
Q

O2 cylinder

A
  • Full E Cylinder is about 1900 psi in gaseous state only
  • Psi will decrease as O2 is being used
42
Q

N2O cylinder

A
  • Full E cylinder has gaseous 750 psi and liquid states
  • 750 psi will stay there until the moment of empty tank
43
Q

o2 cylinders per n2o cylinders

A

2.5

44
Q

Regulator ( Reducing valves)

A
  • Reduce incoming cylinder pressure to ~50psi
45
Q

Reservoir bag

A
  • 3 liter reservoir bag is commonly used in Dentistry
  • Provide additional gas on demand if patient exceed the gas flow being delivered
  • Monitoring respiration
46
Q

Scavenging nasal hood

A
  • Eliminate exhaled N2O from the ambient air
47
Q

Preoperative instructions for inhalation
* food?
* flow rates? (adult vs kid)
* COPD and CHF with partial obstruction?
* Reservoir Bag?

A
  • No heavy meal 4 hours prior to N2O-O2 sedation
  • Determine proper flow rate for the patient
  • 6L/min flow of 100% O2 for adult
  • 3-5L/min for smaller pediatric patient
  • COPD and CHF with partial obstruction may require larger volume
  • Reservoir Bag
48
Q

Minimum O 2 delivering to Nitrous
Oxide sedation patient is ?

A

Minimum O 2 delivering to Nitrous
Oxide sedation patient is 30%

49
Q

Inhalational sedation technique, begin with? titration?

A
50
Q

General Algorithm to a sedation appt

A
51
Q

How do you determine the “right” flow volume

A
  • Reservoir bag
  • Reservoir bag remains partially inflated and deflates and inflates partially with
    each breath usually indicates that the minute volume is adequate
52
Q

Totally Deflated reservoir bag causes?

A
  • Minute volume of gas is inadequate
  • Large leak at the nasal hood
  • Vacuum on the scavenging system is too high
53
Q

Overly Inflated reservoir causes?

A
  • Minute volume of gas is too great
  • Hose obstruction
54
Q

progression of n2o effects on pt

A
55
Q

How do you know if you are “in the zone”?

proper level n2o?

A
  • Relaxation of hands
  • Slower verbal responses
  • Difficulty in phrasing replies
  • Slower physical responses
56
Q

discharging the pt

primary determinant and vital signs

A
57
Q

Complications of n2o

A

OS 3 (6 decks)

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