QUICK REFERENCE GUIDE
NITROUS OXIDE/OXYGEN CONSCIOUS SEDATION
CONSIDERATIONS and RECOMMENDATIONS
PRIOR TO SEDATION APPOINTMENT
1. Health History Review: Determine client’s ASA
Classification
a. Determine if medical consultation is
required prior to scheduling sedation appt.
2. Obtain informed consent from the client,
parent or legal guardian (agent).
3. To help decrease client anxiety and stress,
schedule sedation appointments early in the
day. Do not keep the client waiting for an
extended time in the reception area.
4. Pre-operative instructions to the client should
include:
a. Wear loose clothing
b. Do not eat for three hours prior to
appointment
c. Likely need an escort
5. Expect and be prepared for occasional adverse
outcomes (e.g., relaxation is not achieved,
medical complications).
DAY OF APPOINTMENT
1. Do a thorough equipment check prior to
initiating sedation appointment. All equipment
should be fully functional: tanks, mask (proper
fit, no leaks), reservoir bag, monitoring equip.
2. Seat client and obtain preoperative vital signs.
a. Blood Pressure = Ideal 120/80
b. Pulse rate = Adults – 60 80
c. Respiration rate =
Adults (12 20);
Children (8 and under 20 40)
d. Oxygen Saturation (Pulse Oximeter) should
be 95%; 75 90 mild hypoxia)
3. Ensure client readiness
a. Check for anything that pertains to airway:
partials/large tongue
b. Tell them of possible effects – (e.g. body
warm, tingling toes/fingers; tingling
lips/tongue; dreams seem real)
c. Position the client where treatment will take
place to minimize motion after sedation is
initiated.
INITIATION OF TREATMENT
1. Apply nasal hood. Start with straight
oxygen. Make sure the client is
breathing comfortably before you
introduce the nitrous oxide. Watch the
expansion of the reservoir bag and
adjust up and down as needed.
Approximate flow rates are:
a. Adults - 5-7 l/min
b. Children - 3-5 l/min
2. Titrate the nitrous oxide upward by
~10% every 60 seconds or until
desired endpoint is achieved. If signs
of over-sedation are observed,
decrease nitrous oxide concentration
by 5% increments until client comfort
is achieved. Remember, the goal is
to keep the client relaxed and
comfortable.
a. Most clients will respond favorably
at 25- 40% nitrous oxide. If not
appropriately sedated at 50%,
higher concentrations will probably
be ineffective or cause unwanted
side effects.
3. Initiate treatment. Provide pain
management techniques such as local
anaesthetic as needed.
4. Do not leave client alone during the
procedure. Continue to monitor client’s
vital signs and for desired level of
sedation throughout treatment.
5. For procedures longer than 30
minutes, reduce the % of nitrous
oxide. The amount of reduction is
client and procedure specific. Ensure
the client remains comfortable and
relaxed; if not, increase the % until
comfort level is achieved again.
6. Towards the end of the procedure,
discontinue nitrous oxide and
administer 100% oxygen for at least
five minutes.
DISCHARGING CLIENT
1. Take postoperative vital signs:
a. Blood Pressure = within 10 mm
Hg of preoperative readings (both
systolic and diastolic)
b. Pulse rate = within 10 beats
c. Respiration rate = within 5 beats
2. Client should be: Awake, alert,
cognizant (x3) – oriented to time,
person, and place.
3. Discharge client when fully clinically
recovered.
4. Client should be discharged to the care
of a responsible adult.