Nurses Compass
Drug Guide
Nitrous Oxide
Classification
Therapeutic: Analgesic and Sedative
Pharmacological: Inhalational anesthetic and analgesic
FDA Approved Indications
- Short-term dental procedures
- Intraoperative and postoperative analgesia and anesthesia
Mechanism of Action
Nitrous oxide acts on the central nervous system, producing analgesia and anesthesia primarily through modulation of neuronal ion channels, including NMDA receptors, and increasing endogenous opioid activity.
Dosage and Administration
Adult: Typically, inhaled at concentrations of 30-70% mixed with oxygen, titrated to effect.
Pediatric: Doses tailored based on age, weight, and procedural requirements, generally similar concentration ranges as adults.
Geriatric: Use with caution; start at lower concentrations due to increased sensitivity and comorbidities.
Renal Impairment: No specific dose adjustment; however, renal function should be monitored in prolonged use.
Hepatic Impairment: No specific dose adjustment, but caution advised as hepatic metabolism of some components occurs.
Pharmacokinetics
Absorption: Rapid absorption through the alveoli, providing quick onset of action.
Distribution: Well distributed throughout the body, including the central nervous system.
Metabolism: Minimal metabolism; most nitrous oxide is exhaled unchanged.
Excretion: Exhaled unchanged via the lungs.
Half Life: Approximately minutes, given its rapid onset and recovery.
Contraindications
- Patients with pneumothorax, bowel obstruction, middle ear blockages, or any condition where increased air pressure may be hazardous.
- Previous adverse reactions to nitrous oxide.
Precautions
- Use with caution in patients with COPD, vitamin B12 deficiency, or neurological disorders.
Adverse Reactions - Common
- Nausea or vomiting (Common)
- Dizziness (Common)
- Sedation (Common)
Adverse Reactions - Serious
- Depression of ventilation or consciousness (rare) (Rare)
- Psychological reactions such as anxiety or hallucinations (rare) (Rare)
- Myelopathy due to vitamin B12 deficiency (with prolonged exposure) (Rare)
Drug-Drug Interactions
- Potential potentiation with other CNS depressants including opioids, benzodiazepines.
- Vitamin B12 antagonists or deficiencies may increase risk of neurological effects.
Drug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Assess baseline mental status, respiratory function, and allergies.
Diagnoses:
- Risk for injury related to dizziness or hallucinations.
- Impaired gas exchange.
Implementation: Monitor vital signs and level of consciousness during administration. Ensure proper delivery equipment and scavenging systems.
Evaluation: Assess pain relief, patient comfort, and any adverse reactions.
Patient/Family Teaching
- Inform about the sensation of euphoria or tingling.
- Report any dizziness, nausea, or unresponsiveness.
- Advise postoperative monitoring if applicable.
Special Considerations
Black Box Warnings:
- Potential for asphyxiation if improperly administered or with inadequate scavenging.
- Risks associated with misuse or overuse.
Genetic Factors: No specific genetic factors identified.
Lab Test Interference: Minimal, but prolonged exposure may affect vitamin B12 levels or methylmalonic acid tests.
Overdose Management
Signs/Symptoms: Loss of consciousness, respiratory depression, hypoxia.
Treatment: Administer 100% oxygen, support ventilation, and monitor vital signs. Remove exposure source.
Storage and Handling
Storage: Store in a cool, dry, well-ventilated area in a tightly sealed container.
Stability: Stable under recommended storage conditions.