Aerosol generation during paediatric procedural sedation with continuous-flow nitrous oxide suggests a low risk of airborne viral transmission to health-care workers.

Abstract

Inhaled nitrous oxide is a common form of procedural sedation in paediatric care. During the COVID-19 pandemic, concerns about potential aerosol generation and associated viral transmission to health-care workers have led to controversy regarding its use. We aimed to measure the degree of aerosol generation during continuous flow nitrous oxide sedation to inform future guidelines. Aerosol numbers in the respirable range were measured using a particle counter during 30 procedures undertaken in children under nitrous oxide sedation in the Emergency Department. Changes from baseline measurements were greatest in particles in the 0.3μm range. The mean increase from baseline in 0.3μm particles per cubic metre was 18 022 (95% confidence interval (CI) 5949-30 096) after the child entered the room, and 2931 (95% CI -4407 to 10 269) during nitrous oxide administration. Variation of respirable particle numbers from baseline levels was no greater during nitrous oxide administration than for breathing and talking asymptomatic children. These results suggest the additional risk of airborne viral transmission to staff during inhaled nitrous oxide sedation is low.