Nitrous Oxide

Nitrous Oxide Surgery

Inhalation sedation, laughing gas, relative analgesia, RA, happy gas, gas, nitrous, nitrous oxide, N2O-O2… this one has more names than any other sedation technique! And deservedly so. Inhalation sedation with nitrous oxide (N2O) and oxygen (O2) has been described as “representing the most nearly ‘ideal’ clinical sedative circumstance”…

Nitrous oxide has been used for anesthesia in dentistry since the 1840s. Nitrous oxide is administered through a demand-valve inhaler over the nose that only releases gas when the patient inhales through the nose.

What are the advantages of nitrous oxide?

  • Nitrous oxide works very rapidly – it reaches the brain within 20 seconds, and relaxation and pain-killing properties develop after 2 or 3 minutes.
  • The depth of sedation can be altered from moment to moment, allowing the medical staff to increase or decrease the depth of sedation. Other sedation techniques don’t allow for this.
  • Other sedation techniques have a fixed duration of action (because the effects of pills or intravenous drugs last for a specific time span), whereas gas can be given for the exact time span it’s needed for. It can also be switched off when not needed and then switched on again.
  • There’s no “hangover” effect – the gas is eliminated from the body within 3 to 5 minutes after the gas supply is stopped. You can safely drive home and don’t need an escort.
  • With nitrous oxide, it’s easy to give incremental doses until the desired action is obtained (this is called “titration”). So the administrator has virtually absolute control over the action of the drug, preventing the possibility of accidental overdoses. While giving incremental doses is possible with IV sedation, it’s not possible with oral sedation.
  • For certain procedures – those involving gums rather than teeth (e. g. deep cleaning) – it may be possible to use nitrous instead of local anaesthesia. N2O acts as a painkiller on soft tissues such as gums. However, its pain-relieving effects vary a lot from person to person and can’t be relied upon.
  • No injection is required. In cases of very severe needle phobia, getting laughing gas first can help you feel relaxed enough to allow the needle required for IV sedation to be inserted in your arm or hand. The very deep state of sedation achievable through IV sedation will then allow you to accept local anaesthetic.
  • Inhalation sedation is very safe. It has very few side effects and the drugs used have no ill effects on the heart, lungs, liver, kidneys, or brain.
  • Inhalation sedation has been found to be very effective in eliminating or at least minimizing severe gagging.