Fixed 50% Nitrous Oxide Oxygen Mixture for Painful Procedures: A French Survey

Abstract

One thousand nineteen EMONO inhalations from 31 centers that agreed to participate in this 2-month survey were analyzed. Median (range) age was 6.4 (0-18) years. Four percent (46) of children were 12 months old or younger, 29% (295) were 5 years old or younger, 45% (459) were 6 to 10 years old, and 26% (265) were older than 10 years of age. The procedures performed with EMONO inhalation were: lumbar punctures (286), bone marrow aspirations (BMA; 231), laceration repairs (215), minor procedures (75), minor surgery (53), punctures (49), fractures (45), dental care (43), and pulmonary endoscopy (22). Nine percent of procedures were undertaken without the presence of a physician; the child being observed only by the attending nurse. A drug association was noted in 182 (17.9%) of procedures: midazolam (63%), acetaminophen (18%), nalbuphine (8.5%), hydroxyzine (5%), flunitrazepam (2%), chlorazepate (2%), morphine (1%), and lorazepam (.5%). EMLA cream (Astra) was applied in 98.6% of lumbar punctures, 93.7% of BMA, and 54.2% of punctures including lymph nodes, hematoma, or renal biopsies. Lidocaine infiltration was performed in 51% of minor surgery procedures, 40% of laceration repairs, and 28% of BMA. The inhalation system included a whistle, a scented mask, and a nonrebreathing respiratory valve in 48.9%, 71.2%, and 78.3% of the patients, respectively. Initial physical restraint was needed in 18. 2% of all the patients. Inhalation refusal was noted in 129 (12.7%) children; of these, 53 had an alternative method of analgesia (EMLA or lidocaine infiltration), 15 had no other analgesia, and in the remaining 61, EMONO inhalation was maintained against the child's will. Median (interquartile) inhalation length was 4 (3-5) minutes before starting the procedure and 6 (6-15) minutes for the total inhalation. Median (interquartile) procedural pain evaluations were 9 (0-30) for children on a 0 to 100 visual analog scale, 1 (0-3) for both nurses and parents on a 0 to 10 numerical scale. Median (interquartile) procedural pain as evaluated by nurses for the 3 most frequent procedures were 0 (0-2) for lumbar punctures, 2 (0-4) for bone marrow aspiration, and 2 (0-4) for laceration repair. Comparison of pain assessed by nurses in children 3 years old or younger and those older than 3 years of age showed a median (range) score of 2 (0-10) versus 1 (0-10), respectively. Pain self-assessment was completed in 647 children 6 years of age or older. Median (interquartile) children pain assessments were as follows: lumbar puncture (5; 0-20), bone marrow aspiration (12.5; 0-40), laceration repair (12; 0-40), minor procedures (18; 0-32), minor surgery (10; 0-35), punctures (0; 0-18), fracture (15; 0-30), dental care (20; 0-40), and pulmonary endoscopy (15; 0-30). Ninety-three percent of the 647 children who were able to answer the question said they would accept EMONO analgesia if a new procedure were to be performed. Behavioral reactions during procedures varied with age of the child; cry was observed in 44.1%, 24.4%, 12.9%, and 11.2% of chil...

Sedation with 50% nitrous oxide/oxygen for outpatient dental treatment in individuals with intellectual disability

“…12,15,16 The present study focused on the sedative effects of the 50% N 2 O/O 2 mixture and did not evaluate the analgesic effects, which are more usually the primary measurement of success in medical studies. 4,11,17 The systematic injection of a local anaesthetic for any potentially painful procedure could, therefore, explain the high percentage of success in comparison with certain studies in medical or surgical fields. 17 The increase in the Venham score between T1 and T2 showed a slight behavioural reaction to the injection of local anaesthesia.…”

“…Local anaesthesia with 4% articaine was performed if there was the least risk of pain during the procedure. 11,12 After completion of treatment, the patients were kept under observation for at least 10 minutes. On the rare occasions where nausea or vomiting was experienced by the patient, sedation was stopped momentarily but continued as soon as the patient became comfortable.…”

In children, nitrous oxide decreases pain on injection of propofol mixed with lidocaine

“…N 2 O has been used for iv cannulation in children 10,11 and for other short painful procedures both in and outside operating rooms in hospitals. 12,13 High concentration of N 2 0 such as 70%, may cause side effects such as excitement, dysphoria, nausea, restlessness and opisthotonic movements, 10 explaining why we chose to use a concentration of 50%. N 2 O is widely available and easy to administer.…”

Uso do óxido nitroso em pediatria

“…Nitrous oxide can be used as a method of sedation and analgesia in children in several clinical situations, alone or in combination with other analgesic techniques, such as analgesic drugs, eutectic mixture of local anesthetics (EMLA) and lidocaine infiltration 37 (B).…”