Patient Monitoring for Nitrous Oxide Analgesia Delivery

Recertification for Dental Hygienist & Registered Dental Assistants

Presented by
Department of Oral and Maxillofacial Surgery …

This course meets the requirements set forth by the NJ Dental Board to provide three hours of didactic training necessary for recertification of a licensed dental hygienist or registered dental assistant practicing under direct supervision of a licensed dentist to monitor a patient whom the supervising dentist has administered nitrous oxide/oxygen inhalational anesthesia. Particular emphasis will be given to recognition of complications and other untoward events so that participants are able to quickly terminate the nitrous oxide analgesia delivery along with other necessary appropriate steps including summoning the supervising dentist. This course will be in lecture format with group discussion.

Objectives:
Upon completion of this course participants should:

• Be able to take a medical history and complete a review of systems based upon the patient interview.
• Recognize and assist in management of common medical emergencies in the dental office.
• Understand the pharmacology of nitrous oxide and its effects on organ systems.
• Understand techniques for nitrous oxide analgesia delivery including preoxygenation, titration, monitoring and termination of anesthesia delivery.
• Be aware of complications of nitrous oxide analgesia administration including their recognition and management.
• Review safety features of modern nitrous oxide analgesia armamentarium including scavenging and monitoring systems available today.

Course Outline and Lectures:

Medical Assessment of patient.

• History taking.
• System review: central nervous system, cardiovascular, and pulmonary.
• Implications of medical history on delivery of anesthetic agents.

Common Medical Emergencies in the Dental Office.

• Monitoring vital signs.
• Emergency equipment and preparedness.
• Recognition of common medical emergencies and treatment: allergy and anaphylaxis, chest pain and cardiac arrest, hypotension, bronchospasm, larygnospasm, and syncope.

Pharmacology of Nitrous Oxide.

• Physical properties.
• Chemical properties.
• Potency.
• Systemic Effects: central nervous system, cardiovascular system, and respiratory system.

Armamentarium for Nitrous Oxide Analgesia Delivery.

• Continuous flow units.
• Compressed gas cylinders.
• Safety features: color coding, pin index system, minimal oxygen delivery, and oxygen fail safe mechanism.
• Flowmeters.
• Reservoir bag.
• Breathing apparatus.
• Scavenging system.

Techniques of Nitrous Oxide Analgesia Administration.

• Pretreatment assessment.
• Preparation of the equipment.
• Preoxygenation and titration techniques.
• Patient monitoring.
• Anesthetic termination.
• Postoperative patient assessment and discharge.

Complications of Nitrous Oxide Analgesia.

• Perspiration / Shivering.
• Expectoration.
• Behavioral problems.
• Nausea and vomiting.