Nitrous Oxide-Oxygen Evaluation Criteria

Introduction:
1. State the indications and contraindications for patient selection
for N2O-O2 sedation. Introduce the patient to N2O-O2 sedation at
an appointment prior to the day of administration.
Preparation of Equipment:
2. Be sure to check the equipment is in working order and that all
tanks are full or are filled enough for the duration of the
procedure.
3. Open the oxygen tank first, followed by the nitrous oxide tank
with the supplied handle. Know how the gauges will change while
treatment is being performed. O2 = (full) 2000 psi N2O =
(when nitrous liquid is contained in tank) 750 psi
4. Disinfect the nasal hood and other rubber attachments. Check
tubes and reservoir bag for leaks. Attach the scavenger system
and ensure proper operation.
Preparation of the Patient:
5. Call patient 24 hours prior to appt to request they wear loose
clothing, eat a light meal and bring a contact lens case.
6. Request that the patient visit the restroom and void prior to the
start of the sedative procedure. If patient wears contact lenses
ask for removal prior to start of inhalation sedation.
7. Review the medical history questionnaire and record
preoperative vital signs prior to the start of N2O-O2.
Administration Technique:
8. Position the patient in a comfortable position in dental chair
(supine position is preferred).
9. Position the portable inhalation sedation unit behind the patient,
out of his/her line of sight.
10.
Start the flow of O2 at 6L/min (for adult patients) before
placing the nasal hood over the patients nose. Remind the
patient to breathe through nose and keep mouth closed as much
as possible.
11.
Secure the nasal hood firmly, but not tightly. Hoses are
placed around the sides of the dental chair and the slip clamp is
adjusted behind the headrest.
12.
Determine proper flow rate for the patient. Generally, flow
should be adjusted so that the patient breathes comfortably and
does not feel short of gas flow. Patient is able to breathe
comfortably for one minute and the bag remained to 100% full
at all times. (May need to increase flow rate of O2.

13.
Observe the movement of the reservoir bag. Confirm the
bag was neither collapsed nor over inflated at any time. Ideally,
the bag should move slightly inward with each inhalation of the
patient.
14.
Begins titration of N2O. First increases N2O to 1L/min, then
decreases O2. by 1L/min. This should be done over several
minutes time so the patient becomes accustomed to each level
of nitrous sedation.
15.
Observe the patient for 60-90 seconds. Asks patient openended questions, ie How do you feel? What do you feel? Talks
to the patient at regular intervals.
16.
Continues titration of N2O by L. First increases N2O by
0.5L/min then decreases N2O2 by 0.5L/min.
17.
Observes the patient for 60-90 seconds. Checks for the
following signs and symptoms.
a. Common signs and symptoms of proper sedation: Lightheadedness, tingling, sensation of arms, legs or oral cavity,
feeling of warmth, floating or heaviness If necessary,
repeat step #16 until above level of sedation is attained.
b. CAUTION: Signs and symptoms of over-sedation:
increased sweating, increased respiration rate, increased
heart rate, increased blood pressure, sleepiness, laughing,
crying, talkativeness, nausea. In the event of oversedation, proceed to step #19 immediately.
18.
Begins dental treatment. Observes the patient and
inhalation sedation unit during the procedure. Never leave the
patient unattended.
19.
Terminates the flow of N2O: First increases O2 flow to
starting level, then shuts off N2O completely.
20.
Patient receives 100% O2 for 3-5 minutes. Takes off nasal
hood before turning off the O2.
21.
Retakes vital signs: Blood pressure +/- 20mmHg from
baseline; heart rate and rhythm +/- 15 beats/min from baseline
and same rhythm as baseline; respirations +/- 3 breaths/min
from baseline.
22.
Discharges the patient. Records N2O2 sedation in patient
record.
23.
Disinfects the equipment. Closes all tanks. Calls Marissa,
Tom, or Andrew to return the equipment.