18: Practical Considerations

chapter 18 Practical Considerations

In previous chapters of this section, the technique of administration, complications, and current concerns associated with inhalation sedation have been discussed. In this chapter, a number of additional factors are discussed in an attempt to reflect on and evaluate other factors that are important in the completeness of the overall training of the administrator of nitrous oxide-oxygen (N2O-O2). Many of these questions do not usually arise until the clinician has been using inhalation sedation for awhile. It should be remembered that realistically, complications of N2O-O2 sedation are indeed rare, and N2O is a very safe agent for use in the health sciences.


One of the most important factors to consider when using inhalation sedation is that the gases have a very rapid onset of action. Because of this rapid onset, it becomes possible for patients to be titrated to a precise level of sedation. The ability to titrate with inhalation sedation is of considerable importance because it is quite possible that a patient may require different concentrations of N2O-O2 to achieve the same level of sedation at subsequent visits. The absence of titration leads to increased patient reports of negative reactions to N2O-O2, and clinicians begin to shy away from its use. Titration is the only means for the administrator to satisfactorily determine the appropriate level of sedation. Factors that may influence the concentration of N2O-O2 necessary for adequate sedation include the patient’s level of anxiety, expected level of pain, age, and presence of other sedatives or CNS depressants.

Baseline Level of Stress

A significant influence on the level of N2O required for sedation is the patient’s baseline level of stress. The patient’s state of mind has a significant bearing on the manner in which central nervous system (CNS)-depressant drugs act. A patient may arrive at the facility on a day when things have just not gone well. If this patient has any degree of procedural anxiety, it becomes obvious that our sedation technique has a formidable task ahead. Contrast this with the same patient who arrives at the facility having had a simply wonderful day. The concentration of N2O required to sedate this patient will probably be lower than that required in the first situation.

It is impossible, and indeed foolhardy, to discount the influence of outside stresses on the patient. All practicing clinicians have encountered remarkably different behavior patterns from the same patient at different visits. The process of titrating N2O will help compensate for the effects of these outside influences.

As discussed in Chapter 4, it is recommended that the anxious patient and the medically compromised patient be scheduled for their procedure earlier in the day. At this time, presumably following a period of restful sleep, the medically compromised patient is rested and better able to tolerate any additional stresses imposed by the procedure. The fearful patient ought to be treated early in the day for the simple reason that the patient will want to get “it” over with as soon as possible. The procedural appointment might well be the most unpleasant part of this patient’s day. An appointment scheduled late in the day allows the patient more time to worry and for a level of anxiety to increase. Scheduled later in the day, this patient might require significantly greater levels of N2O to achieve sedation than would have been necessary if he or she had been treated earlier in the morning.

Jan 5, 2015 | Posted by in General Dentistry | Comments Off on 18: Practical Considerations
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