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NITROUS OXIDE IN PAINFUL PROCEDURES IN CHILDREN
  1. I Brunsson1
  1. 1Head of Department of Anaesthesia and ICU, Al Wasl Hospital, Dubai, UAE

Abstract

Medical procedures in children often cause both pain and anxiety. The procedural pain is normally short-lasting and intense. It is well known that untreated pain can cause behavioural disturbances, jeopardises the child’s confidence in the medical staff and makes future hospital contacts worse. Also, an anxious child is more sensitive to pain. The aim of the treatment is therefore to decrease both the pain and anxiety as much as possible and to relax the patients so they do not move during the procedure.

Painful procedures can be both pharmacologically and non-pharmacologically treated. Non-pharmacological methods are most often not sufficient to treat procedural pain on its own but should be used as an adjuvant treatment of the pain. Examples of non-pharmacological methods are: information for the child and its parents; distraction of the child during the procedure. Examples of distraction are: fairy tale reading, music, film, guided association and nitrous oxide (GAN), playstation games, guided imagery and virtual reality.

The medications used for medical procedures can be divided into: sedatives such as midazolam, chloralhydrate and low-dose propofol; weak analgesics such as paracetamol, non-steroidal anti-inflammatory drugs; opioids; combined sedatives and analgesics such as nitrous oxide, low-dose ketamine and β2 blocking agents; local anaesthetics; general anaesthetics.

It is advisable to combine weak analgesics and/or local anaesthetics with the other medications when possible. The combination of opioids with other sedatives can, however, cause general anaesthesia. Sedatives alone should not be used for painful procedures.

The ideal drug for procedural pain should give conscious sedation and potent analgesia, have fast onset, short duration, no respiratory depression, no other major or minor side effects and maintain the protective laryngeal reflexes.

Inhalation of nitrous oxide/oxygen gives mild sedation, is fast in onset, short duration, gives no respiratory depression, maintains the protective laryngeal reflexes, has no major side effects, has few and reversible minor side effects but might not be potent enough for the more painful procedures.

The lecture will give an overview over which procedures are suitable for treatment with inhalation of nitrous oxide/oxygen, show our own experiences combining nitrous oxide with a special method of distraction called GAN, discuss what concentration of nitrous oxide should be used, discuss various aspects of safety when giving treatment with inhalation of nitrous oxide/oxygen and discuss health economy issues.

Conclusion Treatment of procedural pain in children is important but often overlooked. Inhalation of nitrous oxide/oxygen has both analgesic and mild sedative effects combined with fast onset and short duration, which makes it suitable for treating procedural pain. Inhalation of nitrous oxide/oxygen has been shown to be a safe and effective method evaluated for many painful procedures in children. Compared with general anaesthesia, inhalation of nitrous oxide is safer and saves time and money for both the hospital and the family. Inhalation of nitrous oxide/oxygen can be administered by both nurses and doctors after education.

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