Success rate of nitrous oxide-oxygen procedural sedation in dental patients: systematic review and meta-analysis

Abstract

The aim of this systematic review was to determine the success rate of nitrous oxide-oxygen procedural sedation (NOIS) in dentistry. A systematic digital search was conducted for publications or reports of randomized controlled trials evaluating the clinical performance of NOIS. Abstracts of research papers were screened for suitability, and full-text articles were obtained for those who met the inclusion and exclusion criteria accordingly. The quality of the studies was assessed using the revised Cochrane risk-of-bias tool (RoB 2). A total of 19 articles (eight randomized clinical trials with parallel intervention groups and 11 crossover trials), published between May 1988 and August 2019, were finally selected for this review. The studies followed 1293 patients reporting NOIS success rates, with a cumulative mean value of 94.9% (95% CI: 88.8–98.9%). Thirteen trials were conducted on pediatric populations (1098 patients), and the remaining six were conducted on adults (195 patients), with cumulative efficacy rates of 91.9% (95% CI: 82.5–98.1%) and 99.9% (95% CI: 97.7–100.0%), respectively. The difference was statistically significant (P = 0.002). Completion of treatment and Section IV of the Houpt scale were the most used efficacy criteria. Within the limitations of this systematic review, the present study provides important information on the efficacy rate of NOIS. However, further well-designed and well-documented clinical trials are required and there is a need to develop guidelines for standardization of criteria and definition of success in procedural sedation. Currently, completion of treatment is the most used parameter in clinical practice, though many others also do exist at the same time. To maximize NOIS efficacy, clinicians should strictly consider appropriate indications for the procedure.

The Use of Equimolar Mixtures of Nitrous Oxide and Oxygen in Oral Surgery—A Retrospective Study of Patients in a Swiss University Hospital Setting

“…This study revealed a notable success rate of 98.2%, affirming the effectiveness of nitrous oxide/oxygen inhalation sedation (NOIS) in dental treatments. These results align with previous research studies and are consistent with the outcomes of a recent systematic review conducted by Rossit et al, who reported an overall efficacy rate of 95% (CI: 88.8-98.9%) [5,8,12,16].…”

“…Various pharmacological and non-pharmacological tools have been developed to address dental anxiety and facilitate the treatment of phobic patients. Nitrous oxide–oxygen inhaled sedation (NOIS) represents one of the most effective and well-established pharmacological approaches to reducing anxiety and pain during dental treatment [ 3 , 4 , 5 ]. NOIS involves the administration of an equimolar mixture of nitrous oxide and oxygen (EMONO), which has been shown to induce a state of analgesia, anxiolysis, and muscle relaxation by acting on type A γ-aminobutyric acid (GABAA) and N-methyl-D-aspartate (NMDA) glutamate receptors [ 6 ].…”

Uso da sedação inalatória com óxido nitroso e oxigênio como estratégia para proporcionar conforto e reduzir a ansiedade durante procedimentos cirúrgicos: série de casos

“…As evidências científicas suportam a afirmação de que a sedação inalatória com óxido nitroso e oxigênio é eficaz no manejo do comportamento 20 e da dor/distress de crianças em tratamento odontológico 21 . Investigações sobre a preferência dos pais/cuidadores em relação às técnicas de manejo do comportamento reforçam os resultados positivos para a sedação inalatória indicando que ela é preferida em comparação com outras como a estabilização protetora 19,22 .…”

Procedural sedation in pediatric dentistry: a narrative review

“…Research investigating nitrous oxide as a sole therapeutic agent has demonstrated that dental procedures were accomplished in 52% of cases with a 40% concentration, and up to 85% with an equimolar combination, with no reported adverse effects ( 56 , 57 ). According to a systematic review and meta-analysis, the estimated efficacy rates of nitrous oxide-oxygen procedural sedation in pediatric populations was 91.9% (95% CI:82.5 ~ 98.2%) ( 58 ). The effectiveness of nitrous oxide-oxygen procedural sedation is diminished in cases of severe anxiety or fear.…”