16: Inhalation Sedation: Complications

chapter 16 Inhalation Sedation: Complications

Complications with nitrous-oxygen are rare indeed; however, there is no technique that does not have the potential for complications. Complications with nitrous oxide (N2O) almost have to be intentional because this form of sedation is extremely safe. The usual cause is inadequate or incomplete training. Combining N2O with one or more other sedative agents can cause oversedation. N2O is forgiving in that most issues that arise are quickly corrected by proper technique. Complications include the following:


The second classification of potential complications—poor patient experience—can be best managed by prevention. Prevention is most easily and best accomplished by titration of the N2O during administration. Titration allows for enough N2O to be given to achieve the desired clinical effect for a given patient for a particular procedure. Most patients who have complications are oversedated. Physical signs and symptoms such as excessive perspiration, nausea and vomiting, hallucinations, expectoration, and increased agitation rather than sedation are all clear signs and symptoms of oversedation. If a patient exhibits any of these signs, the N2O concentration should be decreased, and in a very short time, a reversal of these adverse reactions will be evident and the patient’s status returned to normal. It is truly impressive to observe how quickly a patient will return to a level of cooperation and acceptance of treatment after this decrease in N2O concentration. It is important to keep the oxygen (O2) flow unchanged. The built-in features of modern inhalation sedation units prevent a flow with more than 70% N2O from occurring. This safety feature helps reduce the possibility of oversedation and possible hypoxia.

The primary reason to administer N2O-O2 is to provide a pleasant experience for the patient by altering his or her mood. Anything less is unacceptable. Some patients can have an inexplicable idiosyncratic reaction to a drug, but this is extremely rare with N2O, and there are no true outright contraindications, only relative contraindications. The relative contraindications of N2O-O2 are discussed in Chapter 12.

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Jan 5, 2015 | Posted by in General Dentistry | Comments Off on 16: Inhalation Sedation: Complications

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