Clinical Effects of Nitrous Oxide Conscious Sedation in Children

Meghan Sullivan Walsh January 18, 2011

Literature Review - St. Joseph/LMC Pediatric Dentistry

Clinical Effects of Nitrous Oxide Conscious Sedation in Children

Resident: Meghan Sullivan Walsh

Program: Lutheran Medical Center- Providence

Article Title: Clinical Effects of Nitrous Oxide Conscious Sedation in Children

Authors: Milton I. Houpt, DDS, PhD; Robert Limb, DMD; Richard L. Livingston, MD

Journal: Pediatric Dentistry

Volume (number), Year, Page #’s; 26:2, 2004, pages 29-36

Major Topic: Behavior and clinical effects of nitrous oxide sedation on the pediatric patient.

Overview of Method of Research: Fifty-nine children requiring dental treatment ages four to thirteen were selected for this study. The study was conducted at UMDMJ pediatric dental clinic as well as four private practices. The children were divided into three groups; 1) Age 4 and 4 mos to 6 and 4 months, 2) Age 6 and 5 months to 9 years and 3) Age 9 and one month to 13 years. The children were rated with the Frankl scale before treatment and asked questions regarding their preoperative condition. The children were then asked to draw figures from the Binder Visual Motor Gestalt Test. The figures had a range of difficulty and were selected to parallel the abilities of the selected ages. After the children were administered a concentration of 50% nitrous oxide the evaluation was repeated. The children were also asked about their perception of nitrous oxide. Objective signs were recorded before and five minutes after administration of nitrous Oxide. These signs included 1) open or closed eyes 2) tears 3) trancelike expression 4) smile 5) speaking 6) laughing 7) open or closed hands 8) limp legs 9) abducted feet. Subjective symptoms were assessed prior to and 5 minutes after nitrous oxide administration. These questions included 1) How do you feel? 2) Do you feel different? 3) Do you like the funny air? 4) Does your lip feel different 5) How does your head feel? 6) How does your belly feel? 7) How do your fingers feel? 8) How do your toes feel? The following choices were given: ok, tingly, warm, cold, light and heavy. Overall condition choices were good, bad, sleepy and OK. The practitioner then proceeded with the restorative treatment.

Findings: Objective findings showed a high prevalence in open hands, (90%), followed by limp legs, (81%), and abduction of feet, (31%). Smiling occurred at 66% where as trancelike expression occurred at 44%. Subjective symptoms showed a high percentage, 75%, of children reporting feeling good with Nitrous Oxide. Almost all children reported liking Nitrous Oxide (95%) and 85% stated they felt different. A sensation in the lip was reported by 58%. The only statistical different reported with the age groupings was that the older group reported feelings of sleepiness and lightheadedness as well as warmth of fingers and abdomen. With reference to the psychomotor effects and four figure drawings, all three ages groups showed no statistical difference in errors before or after administration of nitrous oxide.

Key Points: Summary: One important finding was the positive attitude expressed by the children when asked if they liked the feeling of nitrous oxide. 86% also reported feeling ‘differently.’ These findings do show a high acceptance rate as well as a high subjective feeling of sedation. In addition, there were many observable clinical signs of sedation with these patients. The only patient group that expressed feelings of lightheadedness and dizziness were the third and older age group. The authors believe this could also be a matter of the younger age groupings not having a clear understanding of these descriptions. To surprise of the authors, the nitrous oxide had little effect on the Visual Motor perception abilities.

Assessment of the Article: I enjoyed this well organized study and article. Often times we assume that children are incapable of being studied subjectively and objectively due to their age and understanding of feelings and and descriptions. I appreciated the fact that the authors attempted to study the pediatric population using terminology and simple age appropriate responses and answers to the effects of nitrous oxide.