[Safety and effectiveness of nitrous oxide for sedation-analgesia in emergency departments]

Improving the Utilisation of Nitrous Oxide in Paediatric Patients to Manage Procedural Pain and Procedural Anxiety

The aim in this study was to understand current practice and use of nitrous oxide for management of procedural-related pain and procedural anxiety, to identify perceived barriers to use of nitrous oxide and to develop an understanding of patients, families, and nurse awareness and knowledge of the use of nitrous oxide in an Australian tertiary pediatric oncology/hematology short stay unit. Three online questionnaires (patients, parents, and nursing staff) were developed and completed between September and November 2015. Most children and young people (61%) report receiving nitrous oxide for at least one procedure. Patients, parents, and nurses rated nitrous oxide as highly effective and would like more access to nitrous oxide for the child's pain management. Several barriers to use were reported. These findings suggest that nitrous oxide is effective for pain management; however, its use is inconsistent. Findings can potentially develop standardized processes and improve nurse education and accreditation, which may increase the safety, efficacy, and utilization of nitrous oxide for children's procedural pain management.

Risk of infection and secondary displacement in pediatric supracondylar or lateral condyle fractures treated with unburied Kirchener-wires removed before complete bone healing

This study evaluated the risk of infection and of secondary displacement among children with displaced lateral condyle or supracondylar fractures treated by surgery. The study included a consecutive sample of 84 supracondylar fractures and 21 lateral condyle fractures treated with closed reduction and percutaneous pinning. The mean time to Kirchener wire removal was 29 days (range: 25-37 days) postsurgery. Two out of 105 (1.9%) patients developed infectious complications and two of 105 (1.9%) patients had a secondary displacement. Removal of unburied Kirchener wires before complete bone healing in the physician's office does not increase risk of infection or the risk of secondary displacement. The protocol does, however, enable significant savings and eliminates the need for additional anaesthetic.

Nitrous oxide procedural sedation in non-fasting pediatric patients undergoing minor surgery: a 12-year experience with 1,058 patients

BACKGROUND

Nitrous oxide's safety and efficacy for minor procedures is an alternative to general anesthesia, complex sedation protocols, or local anesthetic alone.

METHODS

A retrospective review of prospectively-collected data (2000-2012) identified 1,058 children who received single-agent nitrous oxide for minor surgery.

RESULTS

Children (n = 1,058, male 42 %, female 58 %) aged 1-23 years (mean = 9.8 + 5.1 years) were identified. Only nine children (0.9 %) fasted. ASA status was I-II in 1,053 (99.5 %) of patients; five (0.5 %) had an ASA III. There were no major complications (desaturation, emergency admission, apnea, airway obstruction, bradycardia) or aborted procedures. Minor complications occurred in 1.8 %; there was no association between these complications and ASA, fasting status or maximum nitrous oxide percentage administered (all p > 0.05). Post-operatively, 98 % of patients denied getting an injection. Eighty-two percent reported mild or no procedural pain.

CONCLUSION

This is the longest reported study using non-anesthesiologist-administered nitrous oxide as a single-agent for minor surgical procedures. The technique provides safe sedation and excellent amnesia, allowing pain and anxiety-reduced surgery with no fasting or postoperative monitoring.