Nitrous oxide was discovered by Joseph Priestly in 1793 as it is used in the last 150 years.
It is widely used anesthetic in dental and medical applications. Nitrous oxide is a small inorganic molecule also called dinitrogen oxide. It consists of colorless and nonflammable gas with a slightly sweet odor.
Nitrous oxide has recreational uses and abuse potential in nonmedical areas.
Nitrous oxide is administered through inhalation, absorbed by diffusion through the lungs, and eliminated via respiration.
It has elimination half-life of about 5 minutes, and it is excreted unchanged through the lungs.
It is a weak general anesthetic thus not typically used alone as agent.
In dentistry, it is primarily used with oxygen for partial sedation in children.
Indications
Nitrous oxide is used during mask induction of general anesthesia in children.
Combined with oxygen and increasing doses of inhalational anesthetic delivered via mask.
Nitrous oxide reduces pain and anxiety in dental procedures.
Nitrous oxide is delivered through a nasal mask that covers the nose to allow a blend with oxygen while the dentist performs procedures.
Nitrous oxide helps pediatric dentists induce amnesia, relaxation, analgesia, and cooperation in children.
Nitrous oxide aids lengthy dental procedures and benefits patients with strong gag reflexes.
Nitrous oxide significantly reduces pain in children during procedures like lumbar puncture and dressing changes.
Nitrous oxide aids young children with juvenile arthritis injections and is effective as anesthesia for minor surgeries like cyst and abscess procedures.
Contraindications
Nitrous oxide is safe but contraindicated in patients with significant respiratory compromise.
Nitrous oxide exits blood to air cavities 34 times faster than nitrogen.
Nitrous oxide is contraindicated after eye surgery with intraocular gas.
Nitrous oxide interferes with vitamin B12, and folate metabolism thus use with caution in patients with these preexisting conditions.
Nitrous oxide is contraindicated in pregnancy due to potential teratogenic and fetal toxic effects.
Dental nitrous oxide is contraindicated for patients with severe nasal congestion, mouth breathers, or nasal mask intolerance.
Outcomes
Patient experiences anxiety reduction and pain relief safely.
Patients often regain normal mental status quickly with oxygenation.
Patient typically returns to normal activities after observation. Over-titration of nitrous may cause rare respiratory issues if monitored.
Lung metabolism prevents nephrotoxicity and hepatotoxicity in this substance. Opioid analgesic mechanism involves spinal neuromodulators for pain relief.
Equipment required
Ambu Bag (Bag-Valve Mask)
Suction Unit
Airway Adjuncts
Emergency Oxygen Supply
Pulse Oximeter
Blood Pressure Cuff
Capnography
Nitrous Oxide Delivery System
Patient Preparation:
Nitrous oxide is commonly used by practitioners, but its complete functions as a weak anesthetic are not fully understood.
Used in general anesthesia at 70% concentration with 30% oxygen or as a carrier gas.
Its anesthetic use is desirable for enabling rapid recovery from anesthesia in under 3 minutes.
Nitrous oxide is safe for patients with malignant hyperthermia history.
Commence with 100% oxygen for 2-3 minutes to ensure oxygenation.
Informed Consent:
Explain the procedure’s risks and potential complications clearly to the patient.
Patient Positioning:
For general anesthesia cases, patients should be positioned in supine position.
For dental anesthesia cases, patients should be positioned reclined in a seated position.
Figure 1. Administering the nitrous oxide gas
Technique
Step 1: Administer Nitrous Oxide
Start with a low concentration of nitrous oxide, such as 20% nitrous oxide / 80% oxygen.
Gradually titrate upwards every 1 to 2 minutes. Target range is 30% to 50% nitrous oxide with at least 30% oxygen always.
Continue communication with the patient, they should be able to response to verbal commands if using minimal sedation.
Step 2: Monitoring During Administration
Maintain a steady concentration once the desired sedation level is reached.
Patients should breathe slowly and deeply through their nose. Avoid sudden changes in flow rates to prevent discomfort.
Step 3: Discontinuation & Recovery
At the end of the procedure, turn off nitrous oxide and switch back to 100% oxygen for at least 3-5 minutes to prevent diffusion hypoxia.
Complications:
Nitrous oxide is a safe anesthetic when used correctly, but complications, including death, can occur, particularly from chronic use or recreational abuse.
Postoperative nausea and vomiting occur with anesthetics.
Inadvertent nitrous oxide use during pregnancy may cause teratogenic effects, decreased fertility, spontaneous abortion, and congenital abnormalities as reported in dental literature.
Most adverse effects are reversible, but peripheral neuropathies and limb spasms might become permanent with symptoms delayed post-exposure.
Vitamin B12 deficiency must be considered in patients with psychiatric or neurological symptoms, especially with nitrous oxide exposure history.
Nitrous oxide exposure may show clinical symptoms days to weeks later, but intramuscular cobalamin administration can be curative in such cases.
»
Home » Procedure » Nitrous Oxide Administration
Nitrous Oxide Administration
Updated :
June 6, 2025
Nitrous oxide was discovered by Joseph Priestly in 1793 as it is used in the last 150 years.
It is widely used anesthetic in dental and medical applications. Nitrous oxide is a small inorganic molecule also called dinitrogen oxide. It consists of colorless and nonflammable gas with a slightly sweet odor.
Nitrous oxide has recreational uses and abuse potential in nonmedical areas.
Nitrous oxide is administered through inhalation, absorbed by diffusion through the lungs, and eliminated via respiration.
It has elimination half-life of about 5 minutes, and it is excreted unchanged through the lungs.
It is a weak general anesthetic thus not typically used alone as agent.
In dentistry, it is primarily used with oxygen for partial sedation in children.
Nitrous oxide is used during mask induction of general anesthesia in children.
Combined with oxygen and increasing doses of inhalational anesthetic delivered via mask.
Nitrous oxide reduces pain and anxiety in dental procedures.
Nitrous oxide is delivered through a nasal mask that covers the nose to allow a blend with oxygen while the dentist performs procedures.
Nitrous oxide helps pediatric dentists induce amnesia, relaxation, analgesia, and cooperation in children.
Nitrous oxide aids lengthy dental procedures and benefits patients with strong gag reflexes.
Nitrous oxide significantly reduces pain in children during procedures like lumbar puncture and dressing changes.
Nitrous oxide aids young children with juvenile arthritis injections and is effective as anesthesia for minor surgeries like cyst and abscess procedures.
Nitrous oxide is safe but contraindicated in patients with significant respiratory compromise.
Nitrous oxide exits blood to air cavities 34 times faster than nitrogen.
Nitrous oxide is contraindicated after eye surgery with intraocular gas.
Nitrous oxide interferes with vitamin B12, and folate metabolism thus use with caution in patients with these preexisting conditions.
Nitrous oxide is contraindicated in pregnancy due to potential teratogenic and fetal toxic effects.
Dental nitrous oxide is contraindicated for patients with severe nasal congestion, mouth breathers, or nasal mask intolerance.
Patient experiences anxiety reduction and pain relief safely.
Patients often regain normal mental status quickly with oxygenation.
Patient typically returns to normal activities after observation. Over-titration of nitrous may cause rare respiratory issues if monitored.
Lung metabolism prevents nephrotoxicity and hepatotoxicity in this substance. Opioid analgesic mechanism involves spinal neuromodulators for pain relief.
Ambu Bag (Bag-Valve Mask)
Suction Unit
Airway Adjuncts
Emergency Oxygen Supply
Pulse Oximeter
Blood Pressure Cuff
Capnography
Nitrous Oxide Delivery System
Patient Preparation:
Nitrous oxide is commonly used by practitioners, but its complete functions as a weak anesthetic are not fully understood.
Used in general anesthesia at 70% concentration with 30% oxygen or as a carrier gas.
Its anesthetic use is desirable for enabling rapid recovery from anesthesia in under 3 minutes.
Nitrous oxide is safe for patients with malignant hyperthermia history.
Commence with 100% oxygen for 2-3 minutes to ensure oxygenation.
Informed Consent:
Explain the procedure’s risks and potential complications clearly to the patient.
Patient Positioning:
For general anesthesia cases, patients should be positioned in supine position.
For dental anesthesia cases, patients should be positioned reclined in a seated position.
Figure 1. Administering the nitrous oxide gas
Step 1: Administer Nitrous Oxide
Start with a low concentration of nitrous oxide, such as 20% nitrous oxide / 80% oxygen.
Gradually titrate upwards every 1 to 2 minutes. Target range is 30% to 50% nitrous oxide with at least 30% oxygen always.
Continue communication with the patient, they should be able to response to verbal commands if using minimal sedation.
Step 2: Monitoring During Administration
Maintain a steady concentration once the desired sedation level is reached.
Patients should breathe slowly and deeply through their nose. Avoid sudden changes in flow rates to prevent discomfort.
Step 3: Discontinuation & Recovery
At the end of the procedure, turn off nitrous oxide and switch back to 100% oxygen for at least 3-5 minutes to prevent diffusion hypoxia.
Complications:
Nitrous oxide is a safe anesthetic when used correctly, but complications, including death, can occur, particularly from chronic use or recreational abuse.
Postoperative nausea and vomiting occur with anesthetics.
Inadvertent nitrous oxide use during pregnancy may cause teratogenic effects, decreased fertility, spontaneous abortion, and congenital abnormalities as reported in dental literature.
Most adverse effects are reversible, but peripheral neuropathies and limb spasms might become permanent with symptoms delayed post-exposure.
Vitamin B12 deficiency must be considered in patients with psychiatric or neurological symptoms, especially with nitrous oxide exposure history.
Nitrous oxide exposure may show clinical symptoms days to weeks later, but intramuscular cobalamin administration can be curative in such cases.
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