Inhalation Sedation

What are the types of Inhalation Sedation?
There are five volatile liquids (desflurane, enflurane, halothane, isoflurane and sevoflurane) and one gas (Nitrous Oxide). Nitrous Oxide is by far the most commonly used of the inhalation sedations in dental offices. Because Nitrous Oxide is the inhalation sedation method of choice, no further mention of the five volatile liquids will be made. Also, for the remainder of this content the terms “Inhalation Sedation” and “Nitrous Oxide” will be used interchangeable.

What is Nitrous Oxide?
Nitrous oxide (N2O) is simply a gas which you can breathe in. It’s colorless, sweet-smelling, and nonirritating. It was discovered in 1772. Its chemical makeup is two Nitrogen and one Oxygen (N2O).

What is the difference between Nitrous Oxide and Nitrous?
Because of its popularity and longevity Nitrous Oxide has many different names. Laughing gas, Nitrous, N2O, N2O-O2, Nitrous Oxide & Oxygen, Happy gas etc. This type of sedation has more synonyms than any other sedation technique! Inhalation sedation with Nitrous Oxide (commonly abbreviated N2O) has been used in dental offices since 1844 and is commonly described as “a most nearly ‘ideal’ clinical sedative.” (Malamed) All of these names are the same and they imply the use of Nitrous Oxide and Oxygen together.

What are the advantages of inhalation sedation?

1. The Onset of Action of inhalation sedation is rapid. It is approximately as fast as intravenous (IV) medications. The onset for both inhalation and IV Sedation is measured in seconds while oral, rectal or intramuscular (IM) sedation methods can take anywhere from 10 to 30 minutes.
2. Peak Clinical Effect is described as the point at which the patient has the “peak effect” from some quantity of drug administered. An analogy would be your car’s climate control system. When you change the heat setting 5 degrees, your car reaches the new temperature fairly quickly. That would be analogous to both inhalation and IV Sedation which both have a quick peak clinical effect. However, oral, rectal and intramuscular have slow peak clinical effects. This would be similar to changing the heat settings 5 degrees in a large gymnasium. It would take some time to finally reach the new desired temperature. The reason this is important is something called “titration”. Titration is the ability to administer small, incremental doses of a drug until a desired clinical action is obtained. This ability to titrate a drug is the greatest safety feature that a dentist has because it allows virtually absolute control over the actions of the drug. In other words, overdoses will not occur with techniques like inhalation and IV Sedation because they can be easily controlled or titrated.
3. The Depth of Sedation can be adjusted moment to moment with inhalation sedation even more so than IV Sedation. Both methods have similar “onset of actions” as mentioned above. However, the dentist can quickly decrease the sedative effects of inhalation sedation. No other method of sedation allows the dentist this level of control and control equals safety.
4. The Nitrous Oxide / Oxygen sedation have a flexible duration of action. Procedures in dentistry range from a few minutes to a few hours. Nitrous can be easily tailored to either short or unexpectedly long procedures because its duration of action is short.
5. The Recovery Time associated with the use of nitrous is only a few minutes. This is because, unlike other forms of sedation (ie. IV, oral, intramuscular), Nitrous is not metabolized by the body. Rather, the gas is just blown off by the body in 3-5 minutes. This means the patient has no wait period or “hangover” at the end of the procedure.
6. Nitrous Oxide has a slight Analgesic Effect which means, for certain procedures, the use of Nitrous can prevent the need for an injection. It is not too often that Nitrous provides a high enough level of analgesia (pain relief) to perform most dental procedures but for routine procedures, like deep cleanings, it can.
7. Nitrous Oxide has few side effects. One side effect is nausea. This is usually associated with quickly changing the amount of Nitrous Oxide administered. If the Nitrous Oxide is slowly titrated, it is uncommon for a patient to feel nauseas. The feelings created with the use of Nitrous Oxide vary among patients and range from a sense of floating, random laughter, relaxed, and sleepiness. Pure oxygen is administered at the end of the procedure and the patient will recover in a few short seconds.
8. As mentioned previously, Nitrous Oxide is not metabolized by the body. Therefore Nitrous Oxide does not have any adverse effects on the kidneys, liver, cardiovascular and respiratory systems or the brain. If you have health issues with any of these bodily systems you may not be a candidate for Intravenous, Intramuscular or Oral Sedation. However, you may still be a candidate for Nitrous Oxide. A comprehensive health history review with your dentist will be necessary to determine whether you are qualified to safely receive Nitrous Oxide sedation.
9. Lastly, if you have a strong gag reflex, Nitrous Oxide may be for you. Nitrous has been shown effective in eliminating or decreasing ones gag reflex.