Monday, April 24, 2006

Laughing Gas (Nitrous Oxide)

Laughing gas, or Nitrous Oxide, has anesthetic properties that were discovered by a dentist named Dr. Horace Wells in 1844. He is usually credited with being the father of anesthesia. It is an inert gas that makes the patient feel light headed, less anxious, and also has some anesthetic properties. It takes effect quickly can be adjusted during admisistration and wears off quickly. The main use in dentistry is the reduction of anxiety. It smells good and is administered with a "Mr. Nose" which is a nasal hood that, in our office anyway, is scented with flavors like bubblegum and strawberry. Children especially like the flavors and the bright colors. There are larger sizes for teenagers with more "adult" flavors like vanilla and pina colada.

Nitrous Oxide's main clinical effect is to lessen anxiety. It works really well and is very safe. Its effects are somewhat mild and, in some patients, additional medications may be needed to relieve anxiety or achieve a more cooperative patient. You can't rely on laughing gas alone to eliminate painful sensations, you still need to use local anesthetics for more invasive procedures, but in some cases Nitrous alone will be enough to eliminate the need for local anesthesia. Its effects are generally described as analgesia.

Is Laughing Gas Safe? Yes, when administered to patients correctly. It is always administered with oxygen. In fact "flowmeters" have a fail-safe mechanism that will deliver no less than 35-40% oxygen. That's almost twice the oxygen concentration in room air (which is 21% O2). I personally don't like to use it higher that 50% Nitrous/50% Oxygen. The only complication I sometimes see is a child who has been on it a really long time and gets a little sick to his stomach. Sort of like riding the merry-go-round one too many times.

Do patient's really laugh? Well, usually not. Usually they just feel good and "zone out' a little although they are still responsive and will cary on a conversation with you. Some kids really do get the giggles. When they do, it's hard for them to stop. That gets us giggling too and it's really funny!

By the way, it's also used in race cars to boost engine output.

12 comments:

Jen Young said...

thank you for this posting.

Anonymous said...

Thanks for this. When the dentist told my husband that my daughter should use it for her cavities, (she's 5), he failed to ask what the side effects are, and how does she come out of it. This takes a little anxiety out of it for me.

Uspech said...

wooow, that's nice!

Anonymous said...

Thank you so much for posting this. I was told my 6 year old needs this to have a tooth pulled d/t over crowding in his mouth. I was a little nervous. This was very helpful!

Anonymous said...

my 7 year old is having laughing gas for a tooth being pulled out. i am really worried bout it will she feel the paib of toothbeing pulled

Anonymous said...

My daughter is four and had the liquid medicine and the gas and the combination did not work ... This was preformed by a pediatric dentist who was certified in conscious sedation and they couldn't even get the work started she was so upset and probably scared to death to ever go back not to mention when we got home she was sick to her stomach from the medicine and not eating or drinking she threw up .. not a good experience at all

Dr. Dean Brandon said...

Medications can be unpredictable especially on younger children. Read more on oral sedation on other posts o the blog here under sedation and behavior management. Sometimes general anesthesia is required to accomplish the work.

daisy garcia said...

I have a 2yr 10 moths old Daughter and was diagnosed with four tiny cavities on her back molars and one tiny cavity in between her front two teeth and at our first dentist they told me I couldn't go back there. Which was not ok with me and a month later I found a pediatric dentist who would let me in but didn't offer any kind of sedation except the shots and used papoose board which I didn't really like but I would be allowed to see how it went. She let them put her in the papoose since I told her it was so she wouldn't be cold and once they four the four shots she cried but once the drilling started she couldn't stop screaming not crying but screamed. I asked if the anestesia had kicked in since they didn't give her a few minutes. They started right away.. I felt so bad for taking her.. Although it lasted like about 30 minutes. And like I said whith the shots she cried but didn't move and once the drilling started she kicked and kicked as if she was being tortures but I didn't say to stop since they had drilled all four and ha to only fill them. I couldn't take her home with them unfilled.. She also gaged and cried hard twice and they didn't turn her face or got her up just suctioned her mouth which seem to get too close to her thoat and would scram with that too:-( so I haven't fixed the one in the front teeth since they said she would need 2 shots one on each tooth and get caps since she can't have them filled since the cavity is too close to the gum and could not stay in place..

daisy garcia said...

Part 2 daisy Garcia
I want to try a different dentist who will let me in and use some kind of sedation . Even tough I haven't seen any change in her behavior at home I did take her to a different dentist to check the front teeth and she would not allow him to even touch her which wasn't a problem before the four fillings.. I should have just sedated her somewhere else for those procedures:-( will the laughing has and drink work for her? Can they administer the laughing gas while she is on my lap and once she has breathed it for like a minute put her in the pappose? That would help us both:) thanks in advance:)

Dr. Dean Brandon said...

Sorry for my short delay in posting your comments, we have been busy this week. Please read more on behavior management (over there on the right side--->). You will see is very common and normal for a two year old patient to cry or be very resistant even for just an examination. They are in the "pre cooperative" stage. As they get older, things get much better. If they are resistant like that, then no matter what you do they will cry and fight. You can softly put in a cotton ball on their cheek and they will scream. So, what can you do? Often they need to be asleep, that is general anesthesia. Sedative drugs might work but they are unpredictable (read also my posts on sedation). Laughing gas is great for older children and teens who are just a little anxious but generally cooperative. It can also be used during sedation or as an adjunct to other things. Most pediatric dentists can pick which method might work the best, but some kids you never know till you try. Then if that does not work, you can change the plan to something that is more effective like general anesthesia.

In office sedation can work, but any sedation or anesthesia is not to be taken lightly and is only done if really needed and under controlled conditions. Two year olds often do not respond adequately to the levels of medication used in an office setting. So, good luck and please read more here on the blog.

chiroJackie said...

I'm an adult who a few years ago had my wisdom teeth removed. At the procedure, the anesthesiologist gave me nitrous oxide to prep me for an IV, which I told them I didn't need, since I was used to IVs but never had a gas mixture before. They insisted, so I tried it. Within minutes, my face started going numb, and I, not knowing the side effects (since I didn't know I was going to have it used before I arrived for the surgery) ended up having a panic attack with accelerated heart rate, hyperventilation, and crying. At first the doctors and nurses thought that I was upset due to the nurse missing my arm vein, but I told them it was the gas. They agreed to reduce the level of Nitrous Oxide, but insisted on still giving me air, just with a reduced N20 level. Once the numbness wore off, I was able to calm, and they were able to eventually get the IV in me without more behavioral mishap. After that, I don't remember anything till I woke up after the extraction. What I was wondering, have you had patients react poorly to the sensations that Nitrous oxides gives, or is my panic attack rare? I think, perhaps, I just have a phobia of breathing in anything but regular air, although helium play with old balloons doesn't bother me.

What do you think?

Dr. Dean Brandon said...

Nitrous oxide is an inert gas. Reactions like that sound much more like anxiety, panic attack if you will. The feeling if being a little but dizzy or disoriented can make (usually older patients ) feel a little to weird. Other than that I have never seem that.