Another massive study reviewing adverse events encountered during procedural sedation – this time with nitrous oxide given in concentrations up to 70%. It is odd that resistance is encountered regarding high concentrations of nitrous oxide – considering 30% O2 is still greater than the fraction of inspired oxygen on room air – but this, and other studies like it, should help allay any concerns.
Out of their 7,802 nitrous administrations, they recorded 9 “potentially serious” adverse events – eight desaturations and one potential aspiration event requiring oropharyngeal suctioning. More importantly, a reasonable percentage of these administrations were in children with comorbid diseases or potentially serious illness that needed sedation for significant procedures – LP, CT scans, NG/G-tube placement, and “other” that included EMGs and botulinium toxin injections. Their rates of serious events are similar to other published series where either zero or <1% potentially serious events occurred – except for the study that reported 30% adverse events, but included “euphoria” and “dreaming” as adverse events.
This is not, however, an ED-only study, and one of the limitations is that they don’t specifically record whether they are able to successfully complete the intended procedure with this method – however, one would imagine, if it didn’t work the first 7,000 times, they wouldn’t have kept doing it…
“Safety of High-Concentration Nitrous Oxide by Nasal Mask for Pediatric Procedural Sedation”
http://www.ncbi.nlm.nih.gov/pubmed/22134227
I would LOVE to have nitrous available for my ED, but we don't. I've been told it is because we don't have the scrubbers installed in the department.