Inhalational Sedation Techniques in Dentistry

Sedation Techniques

• Sedation is a procedure used to reduce anxiety and pain during dental procedures.
• Inhalational sedation, specifically, involves administering nitrous oxide (0-70%) with oxygen
• The technique has a history dating back to 1966, originally termed "Relative Analgesia" but now known as "Inhalational Sedation".
• Nitrous oxide provides supplemental analgesia for minor deficiencies in pain control.

Inhalational Sedation in Dentistry

• Nitrous oxide is mixed with oxygen, and administered via a mask.
• Equipment must include a fail-safe system, preventing 100% nitrous exposure.
• Semi-hypnotic suggestions are used to aid relaxation.
• The preferred terminology is inhalational sedation

Indications for Inhalational Sedation

• Uncooperative children or adults,
• Mildly apprehensive patients
• Patients with medical complications
• Patients with gagging issues.

Contraindications for Inhalational Sedation

• Extreme anxiety or nasal obstruction
• Sinus issues or habitual mouth breathing issues
• Upper respiratory tract infections
• Serious psychiatric conditions
• Chronic Obstructive Pulmonary Disease (COPD)
• First trimester of pregnancy

Advantages of Nitrous Oxide Sedation

• Rapid onset of sedation with a quick recovery period.
• Pleasant, non-irritating odor.
• No post-treatment hangover effects.

Disadvantages of Nitrous Oxide Sedation

• Specialized and expensive equipment is needed
• Occupational hazards include exposure risks to both dental and nursing staff.
• Increased risk of abortion in female dental assistants using nitrous oxide.
• A risk to pregnant patients, especially during the first trimester.
• Proper ventilation and leak testing are necessary.

Color Coding of Compressed Gases

• Oxygen (O₂) is green.
• Nitrous oxide (N₂O) is light blue.
• Nitrogen (N₂) is grey with an orange shoulder.
• Carbon dioxide (CO₂) is grey.
• Helium is brown.

Nitrous Oxide Sedation- Armamentarium

• The equipment includes a continuous-flow inhalation unit, yoke assembly, pressure gauge, low-pressure tubing, and compressed gas cylinders.

Nitrous Oxide Sedation- Armamentarium (Continued)

• Full face masks cover both the nose and mouth.
• Nasal cannulas use short plastic prongs inserted into the nostrils.

Nitrous Oxide Sedation - Preparation and Patient Instructions

• 100% Oxygen is used to begin and end the sedation procedure.
• Patients must follow recommended fasting guidelines.
• Patients must empty their bladder prior to treatment.
• Contact lenses and dentures should be removed before the procedure.

Nitrous Oxide Sedation – Sedation Procedure and Monitoring

• Patients are comfortably positioned in a dental chair.
• Oxygen (5LPM) is administered through a nasal mask.
• Nitrous oxide (10% initially) is gradually increased until reaching 35-40%.
• The concentration is adjusted based on the patient's responses.
• Vital signs, pulse oximeter and ECG monitoring is performed during procedures
• Verbal communication with patients is maintained throughout the procedure.

Nitrous Oxide Sedation – Post-Procedure Care and Safety Protocol

• 100% oxygen is administered for 3-5 minutes after treatment to prevent diffusion hypoxia.
• Patients should be accompanied during the post-sedation period.
• Fine motor activities (driving, operating machinery) are restricted for 24 hours after the procedure

Cardiovascular Diseases

• Inhalational sedative is indicated for Angina Pectoris, Congestive Cardiac Failure, Severe Cardiac Dysrhythmias, Myocardial Infarction, and High Blood Pressure.
• Benefits include analgesic, amnesic, and sedative properties
• Reduces myocardial workload through relaxation
• Supplies a support oxygen-rich environment for the heart
• Intravenous Sedation: Carefully administered slowly in diluted concentrations

Asthma

• Stress can trigger asthma attacks during lighter anesthetics.
• Suggested inhalational agents include Halothane and Sevoflurane (bronchodilator properties, pleasant odor).
• Isoflurane (irritating to airways) is avoided.
• Propofol (minimizing airway irritability by obtuding airway reflexes) and Ketamine (bronchodilator properties, ideal for airway hypersensitivity) are ideal intravenous options to consider.
• Thiopental (exacerbates airway irritability and can lead to bronchospasm) is avoided.

Epilepsy

• Benzodiazepines (e.g., Midazolam) exhibit antiepileptogenic properties and are ideal choices for patients with a history of epilepsy.
• Intravenous sedatives (e.g., Thiopentone or Propofol) are safe and effective management options.
• Avoid long-acting benzodiazepines (e.g., Diazepam, Lorazepam) due to their potential for delayed recovery and respiratory depression in office-based procedures.
• Nitrous Oxide is considered safe for chronic seizure patients, non-epileptogenic, provided hypoxia prevention measures are correctly implemented.

Hepatic Dysfunction

• Nitrous Oxide is a safe and effective option for patients with hepatic dysfunction due to no biotransformation in the liver.
• Halothane is avoided, as it may worsen liver condition.
• Intravenous drugs should be administered in titrated doses.

Chronic Obstructive Pulmonary Disease (COPD)

• COPD patients exhibit elevated carbon dioxide (CO2) levels, and their breathing stimulus is prompted by low oxygen (O2) levels.
• Inhalational sedation using an oxygen-enriched gas mixture can increase blood oxygen levels, reduce natural breathing stimulus, leading to respiratory apnea.

Clinical Indicators of Oversedation

• Excessive sedation is characterized by excessive sleepiness or agitation
• Obstructed airway or difficulties in breathing are indications
• Patients responding slowly or not responding at all indicate a need for adjustment.
• Emotional reactions (laughing, crying, feeling gidiness) can be indicators
• Uncoordinated motor control and incoherent speech point to excessive sedation.

Postoperative Discharge Scoring Systems

• Post-operative morbidity is minimized via Modified Aldrete Score and Post-Anesthesia Discharge Scoring System (PADSS).
• Scores reflect activity, respiration, circulation, consciousness, and oxygen saturation to determine readiness for discharge.
• Evaluates vitals, ambulation, nausea/vomiting, pain, and surgical bleeding during the discharge process.

This quiz explores the techniques of inhalational sedation, particularly the use of nitrous oxide and oxygen in dental procedures. It covers the indications, contraindications, and the history of this sedation method. Test your knowledge on how these techniques help in managing patient anxiety and pain during treatments.