Anxiolysis simply means the removal of anxiety. Anxiety is a common factor in minor surgery be it dental or general medical. One of the best tools in the physicians’ and dentists’ armamentarium to achieve anxiolysis is nitrous oxide mixed with at least 20 per cent and usually 30 per cent oxygen, so the patient is relaxed and anxiety free but fully conscious throughout the procedure. In this state of anxiolysis the patient is relaxed enough to allow administration of local anaesthesia, which does not deepen the state of sedation.
Anxiolysis is a major tool in medicine and dentistry because a relaxed patient free or relatively free of anxiety, but still fully conscious, is in an almost perfect state of anxiolysis for any form of minor surgery or painful medical procedure. The pain can safely and completely banished prior to the operation by administration of a local anaesthetic.
The strong analgesic and hence anxiolytic actions of non-anaesthetic nitrous oxide have been shown to be equivalent to a 15mg dose of morphine. Its wide popularity in dentistry has demonstrated its excellent anxiolytic properties, which together with its cost-effectiveness, safety, rapidity of action, good analgesic and amnesic properties, have resulted in it being described by several researchers and clinicians as close to the ideal agent for conscious sedation. Of course, the memory depressing or amnesic effects are merely temporary and confined to the memories of any trauma related to the surgical procedure. Obviously such a memory-dulling effect is a major advantage of any drug used for anxiolysis.
Another great advantage, which accounts for the mounting popularity in South Africa and elsewhere in the world of using nitrous oxide/oxygen for anxiolysis is that approximately 90% of dental patients who require general anaesthesia can be treated with anxiolytic nitrous oxide/oxygen sedation in an out-patient setting. Thus, its use by doctors could reduce the need for many general anesthetics. And no pre-authorization is required from the medical aid societies when nitrous oxide conscious sedation is used in South Africa.
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