Efficacy Of Nitrous Oxide Research Articles

Efficacy of nitrous oxide in adults undergoing puncture biopsy: A systematic review and meta-analysis of randomized controlled trials.

Nitrous oxide (N2O) with rapid analgesic effect is often used to relieve pain induced by diagnostic procedures. This review was conducted to evaluate the efficacy and safety of N2O in patients undergoing puncture biopsy. We systematically searched PubMed, Embase, the Cochrane Library, Web of Science, Scopus and the ClinicalTrials.gov up to March, 2022. Randomized controlled trials (RCTs) were included if they investigated the effect of N2O in adults undergoing puncture biopsy. The primary outcome was pain score. Secondary outcomes included anxiety score, patient satisfaction and side effects. Twelve RCTs with 1070 patients were included in the qualitative review, of which eleven RCTs were included in the meta-analysis. Pooled analysis suggested that compared with the controls (placebo, lidocaine and midazolam), N2O had better analgesic effect (MD -1.12, 95% CI -2.12 to -0.13, P = 0.03; I2 = 94%). In addition, N2O significantly alleviated patient anxiety (MD = -1.79, 95% CI -2.41 to -1.18, P<0.00001; I2 = 0%) and improved patient satisfaction (MD 1.81, 95% CI 0.11 to 3.50, P = 0.04; I2 = 92%). There was no significant difference regrading the risk of nausea (RR 2.56; 95% CI 0.70 to 9.31, P = 0.15; I2 = 0%), headache (RR 0.62, 95% CI 0.17 to 2.33, P = 0.48; I2 = 46%), dizziness (RR 1.80, 95% CI 0.63 to 5.13, P = 0.27; I2 = 0%) or euphoria (RR 2.67, 95% CI 0.81 to 8.79, P = 0.11; I2 = 8%) between the N2O group and the control group. The present review suggested that N2O might be effective for pain management in patients undergoing puncture biopsy.

Comparison of nitrous oxide/midazolam and nitrous oxide/promethazine for pediatric dental sedation: A randomized, cross-over, clinical trial

This study compared the safety and efficacy of nitrous oxide (N2O)/midazolam and N2O/promethazine for dental treatment of uncooperative children. In this randomized, cross-over, clinical trial investigation Eighteen healthy uncooperative children with a pair of similar teeth requiring the same treatment were included. Combination of N2O/midazolam was given in one visit, where N2O/promethazine was administrated in the other appointment for each patient in a cross-over manner. Oxygen saturation and heart rate as well as behavior parameters according to Houpt behavior scales were recorded. Postoperatively, patients' anxiety and parents' satisfaction were assessed by visual analog score and a questionnaire, respectively. Data were analyzed using Wilcoxon' s signed rank test and Paired t-tests with a P value set at 0.05. Physiologic parameters were within normal limit in both groups. Children in midazolam group were significantly deeper sedated compared to other groups. In the first phase, children sedated with midazolam behaved superiorly in comparison to promethazine, while there was no difference at the final phase of the treatment between the two groups. Both of the drug combinations resulted in acceptable, efficient, and safe sedation outcomes.

Pediatric Dental Sedation Research: Where Do We Stand Today?

Despite the voluminous literature addressing the safety and efficacy of various sedative agents in the pediatric dental setting, the quality literature to form evidence based pediatric dental sedation practice is not available. Our search through PUBMED showed that during 1985-2012, a total of 184 original research papers on pediatric dental sedation were reported, and midazolam clearly dominated with 88 trials on this agent. Despite these large numbers of papers, Cochrane Review was able to pool a weak evidence in favor of midazolam. Data pooling from five heterogeneous high risk of bias trials showed that oral midazolam is associated with more cooperative behavior when compared to a placebo. Further, a very weak evidence regarding efficacy of nitrous oxide was collected from two trials, which could not be pooled. These findings draw attention to the need to address the shortcomings in the current state of pediatric dental sedation research. The present article has been focused on the current status of pediatric dental sedation research, and the limitations in the current research methodology. This paper also suggests recommendations for future research in the field of pediatric dental sedation.

Effect of nitrous oxide inhalation on pain after propofol and rocuronium injection

This prospective, double-blind, placebo-controlled study was designed to determine the efficacy of nitrous oxide (N(2)O) in alleviating the pain that followed sequential injection of propofol and rocuronium. A total of 205 adult patients (age, 18-68 years) received one of the following combinations: NaCl and 100 % O(2) (group C); 0.5 mg/kg lidocaine and 100 % O(2) (group L); NaCl and a mixture of 67 % N(2)O/O(2) (group N); or 0.5 mg/kg lidocaine and a mixture of 67 % N(2)O/O(2) (group LN). Vein occlusion was released after 1 min, and 5 ml propofol was injected over 10 s. Pain was evaluated on a visually enlarged, laminated, numeric rating (0-10) scale. The remainder of the induction dose of propofol (with a 3-ml bolus of normal saline and 0.6 mg/kg rocuronium) was then injected. The response to the rocuronium injection was assessed with a four-point scale (0-3). The incidence and severity of pain from the propofol injection in groups L, N, and LN were significantly lower than those in group C (P < 0.001). Frequency and intensity of the withdrawal response were significantly less in groups N and LN than in groups C and L (no response, P < 0.001; severe response, P < 0.001). Pretreatment with inhaled N(2)O can reduce the pain associated with propofol and rocuronium injection. Moreover, N(2)O (with or without lidocaine) is more effective than lidocaine alone in reducing rocuronium-related withdrawal reactions associated with sequential injection of propofol and rocuronium.

Nitrous Oxide and Evidence-based Medicine: Here We Go Again

Nitrous Oxide and Evidence-based Medicine: Here We Go Again

Effect of nitrous oxide on dental patients with cerebral palsy -- using an electromyogram (EMG) from orofacial muscles as an index.

The efficacy of nitrous oxide (N2O) inhalation on the elevated orofacial muscle tonus during dental treatment in patients with cerebral palsy (CP) was studied by measuring the mean frequency of electromyographic (EMG) discharge, blood pressure (BP) and heart rate (HR) taking mentally retarded patients (MR) as a control. At a pre-treatment stage, the mean frequency of the EMG was higher in the CP patients than in the MR patients. By forcing the jaw open, the mean frequency of the EMG, BP and HR was elevated significantly in both types of patients. The enhanced level of the mean frequency of the EMG was higher in the CP patients than in the MR patients. After inhalation of N2O, the mean frequency was reduced significantly in both types of patients, however, the reduction rate was higher in the CP patients than the MR patients; BP and HR were not affected. These results demonstrate the selective efficacy of N2O in reducing the orofacial muscle tonus in CP patients during dental treatment probably because of the N2O inhibiting the function of the central nervous system. The present study therefore suggests the beneficial properties of N2O induced sedation performed during dental treatment on CP patients.

Effectiveness of nitrous oxide in a rural EMS system

Prehospital systems need a safe, effective analgesic agent for the treatment of patients suffering from pain. Recent studies have documented the efficacy of nitrous oxide in urban and rural settings. This study reviews the findings on 200 patients (157 trauma, 23 medical, 18 musculoskeletal problems) who received nitrous oxide during a 28-month period in a rural EMS system. Eighty-five percent of the patients reported pain relief. Only minor side effects were noted. Patient satisfaction was high, and there was no abuse noted among personnel.