Minimal sedation Nitrous Oxide
The above term is another term for conscious sedation with nitrous oxide/oxygen. Other terms are also used viz., relative analgesia and inhalation sedation. Minimal sedation has been defined as ‘a minimally depressed level of consciousness produced by a pharmacological method, in which the patient retains the ability to independently and continuously maintain an airway and respond normally to tactile stimulation and verbal command. Although cognitive function and co-ordination may be modestly impaired, ventilatory and cardiovascular functions are unaffected.’ [CDSBC Minimal and Moderate Sedation Services in Dentistry
When nitrous oxide/oxygen is used for minimal sedation with added local anesthetics only clinical observation is needed and special monitoring devices such as oxymetry are not required. The use of other drugs such as benzodiazepines or opioids or other central nervous system depressants with minimal sedation with nitrous oxide and oxygen most certainly does require oxymetry and other advanced forms of objective monitoring devices. Those using nitrous oxide and oxygen for minimal sedation evade deeply sedating their patients and/or creating general anaesthesia.
When nitrous oxide/oxygen is given for minor surgery or for treating substance abuse withdrawal states it is titrated until the patient is free of anxiety and in the same state of mind that they would be happy to have any minor surgical treatment performed on them. Titration is a technique where a drug, in this case nitrous oxide, is gradually added to at least 20 per cent and usually 30 percent oxygen until the patient is relaxed, but fully conscious. The technique of titration with nitrous oxide to achieve minimal sedation requires hands on training as well as a full theoretical background, so that the correct individualised dose of nitrous oxide in oxygen is administered to each patient. Recovery from minimal sedation with nitrous oxide and oxygen is accomplished by allowing the patient to breathe pure oxygen for approximately 10 minutes and thereafter the patient waits in the waiting room for a further 30 minutes. After the 30 minute wait in the waiting room the patient is fully capable of driving or operating machines unaided. The rapid recovery from minimal sedation by nitrous oxide/oxygen is one of the major advantages of using it, apart from its amazing safety record and efficacy.
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