Nitrous Oxide Midwife Tip Sheet PDF

M Nitrous Oxide Midwife tip sheet What is nitrous oxide? Nitrous oxide (N2O) is a colourless gas with analgesic and anxiolytic effects. This inhalational anaesthetic is fast-...

M Nitrous Oxide Midwife tip sheet What is nitrous oxide? Nitrous oxide (N2O) is a colourless gas with analgesic and anxiolytic effects. This inhalational anaesthetic is fast-acting, safe and effective for intrapartum pain relief. When would Client satisfaction Study participants linked to maintaining N20 benefit rated satisfaction mobility, and with N2O and control over epidural equally clients? administration of N2O lntrapartum Avoiding pain, epidural, Anxiety To support out-of-hospital during or awaiting especially availability/onset labour (if N2O available when >5cm of other labour in community) dilated pain relief How does N20 work? Several mechanisms of action involved Analgesic effects Increases the release of endogenous Analgesic effects endorphins, dopamine and other work like morphine opioids in the brain and spinal cord Anxiolytic effects Anxiolytic effects work Increases prolactin and decreases cortisol, reducing the hormonal response like benzodiazepine to stress. Activates GABA-A, an inhibitory neurotransmitter. What are the benefits and risks of N20? Adverse effects Rapid onset (30-50 seconds) No effect on fetal Nausea Rapid offset heart rate, umbilical Dizziness/vertigo (1-2 breaths room air) cord gases, Apgar score In mixtures of 50% Preserves client mobility Crosses placenta, but lack of lipid solubility N20/50% Oxygen, No effect on uterine activity Non-invasive prevents accumulation; there is NO respiratory Cost-effective ny residual gas eliminated depression or diffusion when neonate starts hypoxia breathing Can N20 be used during the COVID-19 pandemic? See the AOM FAQ for information about safely using N2O during COVID-19: www.ontariomidwives.ca/covid-19-clinical-faq How to administer N20 1. Prepare equipment 2. Inform client Connect regulator, gas Instruct client to inhale and tubing, filter, mask/mouthpiece, exhale fully into and scavenging tube.* mask/mouthpiece during Check if tank is full enough. contractions, breathe room air between Equipment may vary -. by community/institution.stJ contractions. i 4. Breathe deeply 3. Client to hold apparatus 5. Refill prn The client should Clarify that no other Monitor gas breathe deeply person should hold level and during contractions. mask/mouthpiece for replace tank TheN20will client. Do not use straps only flow during "" as needed. to hold mask in place inhalation.. Supplies needed: Nitrous oxide tank Gas tank regulator (integrated from some suppliers) Mask/mouthpiece Filter (integrated from some suppliers) Gas tubing Scavenged gas tubing (scavenging recommended as COVID precaution) Cylinder cart carrier (optional) References: 1. Collins M. Use of nitrous oxide in maternity core: AWHONN practice brief number 6. Journal of Obstetric, Gynecologic & Neonatal Nursing. 2018 Mor 1 ;47(2):239-42. 2. Emmonouil DE, Quock RM. Advances in understanding the actions of nitrous oxide. Anesthesia progress. 2007;54(1):9-18. 3. Hellams A, Sprague T, Soldonho C, Archambault M. Nitrous oxide for labor analgesia. JMPA. 2018 Jon 1:31(1):41-4. 4. Knuf K, Mooni CV. Nitrous oxide. lnStotPeorls [Internet) 2020 Jul 26. StotPeorls Publishing. Available from: https://www.ncbi.nlrn.nih.gov/books/NBK532922/#:~:text=Nitrous%20oxide%20con%20be%20used,obstetricol%20word%20or%20emergency%20deportment. 5. Nodine PM, Collins MR, Wood CL, Anderson JL, Orlando BS, McNoir BK, Moyer DC, Stein DJ. Nitrous oxide use during labor: Satisfaction, adverse effects, and predictors of conversion to neuroxiol analgesia. Journal of Midwifery & Women's Health. 2020 Moy:65(3):335-41.