78 Nitrous Oxide Use for Children Experiencing Painful Procedures: A Survey of Canadian Paediatric Emergency Physicians’ Knowledge, Attitudes, and Practices

Abstract

Abstract Background Nitrous oxide (N2O) is an inhaled analgesic/anxiolytic gas with ample evidence supporting its safety and efficacy in children. However, its prevalence of use remains low, while its indications in paediatric emergency departments (EDs) across Canada remain unknown. Optimization of safe and appropriate of N2O use in this setting requires an understanding of paediatric emergency providers’ knowledge, attitudes, and practice patterns surrounding its use. Objectives We aimed to characterize physicians’ perceptions and current site-specific processes and procedures surrounding N2O use to understand differences between current evidence and clinical practice and standardize care for children undergoing distressing procedures. Design/Methods This cross-sectional survey was distributed electronically to all physician members of Paediatric Emergency Research Canada (PERC) from February to April 2021. Survey items pertained to N2O availability, comfort with N2O use, and perceived barriers/facilitators to its use. Further, a PERC representative from each site completed a site-specific inventory of N2O policies and procedures. Results Response rate was 67.8% (156/230), with 53.2% (83/156) women; 66.6% (104/156) had paediatric emergency subspecialty training, and mean clinical experience was 14.7 years (SD 8.6). 40.0% (6/15) of sites had N2O available in the ED, and 83.3% (5/6) of these institutions had written policies and/or procedures in place for N2O use in the ED. Overall, 48.7% (76/156) of physicians reported using N2O in their clinical practice. The most common indications for use were fracture/dislocation reduction (69.7%, 53/76), wound closure (60.5%, 46/76), and incision and drainage (59.2%, 45/76). The most common perceived barriers to N2O included concerns about ventilation/scavenging systems (71.2%, 57/80) and unfamiliarity with equipment (52.5%, 42/80). The most common perceived facilitators were N2O availability in the ED (73.0%, 114/156) and clinical experience with N2O (71.7%, 112/156). Of the 51.3% (80/156) physicians who reported not using N2O, 93.7% (75/80) did not have access available at their site; notably, 77.3% (58/75) indicated a desire to have access to N2O. Conclusion Despite evidence to support its use, only half of paediatric emergency physicians in Canada currently use N2O as a tool for treating children’s procedure-related pain and distress. Increasing availability of necessary equipment, protocols, and clinical training surrounding N2O use in children may improve clinicians’ abilities to better manage children’s acute pain and distress in the ED, and other clinical contexts.