True facts about nitrous oxide 
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 True facts about nitrous oxide


[Discription of Nitrous Oxide deleted]

^
^Hope this is of interest.
^D. Gaba, M.D., Asst. Prof. Anesthesia, Stanford

I'm curious as to how safe dentists are when giving out anesthesia...I have a
friend who's father is an Anesthesiologist and he's said that he'd never let a
dentist give him anything other than local and that they aren't fully trained
for anything else (at least by his standards).  

How true is this?  

NT

--------------------------------------------------------------------------------
   // | Nigel Tzeng - STX Inc - NASA/GSFC COBE Project

      |
Amiga | Standard Disclaimer Applies:  The opinions expressed are my own.



Tue, 27 Oct 1992 21:28:21 GMT
 True facts about nitrous oxide
Here's some information to clear up some of the misinformation
which has made its way onto the net concerning nitrous oxide.
I will be brief -- there is one very large book which deals
only with nitrous oxide.

Nitrous oxide is an anesthetic gas.  However, at standard
atmospheric pressure it would take over 100% nitrous oxide
to be a "complete" anesthetic by itself.  It thus is impossible
to produce a true state of surgical anesthesia using nitrous
alone without a hyperbaric chamber.

Nitrous oxide, like virtually all anesthetics, is an
analgesic (pain killer) at lower concentrations.  Fifty
percent nitrous oxide is much more effective than typical
doses of intramuscular morphine as an analgesic.  Nitrous
also has central nervous system effects.  The first parts
of the brain to go to sleep are often the ones that control
the more basic parts of the brain.  This "disinhibition" is
what accounts for the giggles, stupid comments, and the
"laughing" part of laughing gas.  Many people like the spaced
out feeling -- especially in the dentist chair -- although some
don't.

Nitrous is usually given in concentrations of from 30 - 70%.  I
am not sure of dental practices but would guess that 50% is about
what is used (that's what Entonox is).

How does nitrous oxide work?  Nobody knows for sure.  The
mechanism of action of all anesthetics is uncertain (this may
be the only Nobel prize to be won in anesthesiology).
IT DOES NOT WORK BY INTEREFERING WITH OXYGEN METABOLISM.

However, there are important effects on oxygen uptake and
distribution due to nitrous.  1)  If one uses nitrous oxide,
one cannot use 100% oxygen.  This is of importance during surgery
when we put a tube in the windpipe (usually after the patient
is asleep) and can actually deliver pure oxygen.  However, most
patients will do just fine with 30% oxygen (or even less --
room air of course is 21%, but being anesthetized is not the
same as being awake or normal sleep, and more oxygen is
often necessary).  2)  Nitrous oxide is taken up very quickly
by the {*filter*} when first used, and is not very soluble in {*filter*}.
At the end of the procedure when it is turned off, it comes
out of the {*filter*} very quickly, thereby "flooding" the lungs with
nitrous oxide and displacing oxygen.  Since in many anesthetic
circumstances the patient's drive to breath is already blunted
by a combination of {*filter*}, surgical wound pain, mechanical
factors, this displacement of oxygen (bulk gas displacement,
NOT at the receptor level) can cause "diffusion hypoxia" and
the patient could suffer from a relative lack of oxygen.  This is
the reason for give pure oxygen (rather than just room air) at
the end of a nitrous oxide anesthetic.  It is the insolubility of
nitrous that makes its effects wear off so quickly.  So little
is held in the {*filter*} and tissues that when it is turned off it
is ventilated away very quickly.

Hope this is of interest.
D. Gaba, M.D., Asst. Prof. Anesthesia, Stanford



Tue, 27 Oct 1992 12:12:17 GMT
 True facts about nitrous oxide
Contrary to my origine system I am a nurse anesthetist. Nigel, the facts
that Dr.Gaba were very good. I will be interested in his respone to your
question about dentist giving N2O. I am sure that them giving is like
some anesthesia personal. We have good ones and bad ones. The dentist who
have had training in N2O admistration should be competent to give it.

I do know that there are heart patients and some other conditions where
N2O should not be given  at all and I am not sure of the dentist training
in order to make the decision to use it or on who.

I have personally found this discussion very interesting because so many
people have voiced their opinions on pain. The general public or at least
a lot of the ones I work with do not want the alternative to general  
anesthesia and that is what N2O in combination with O2 and other sedatives
should be considered even in the dentist office. There are so many people
who would rather go to sleep and "not know what is going on" it some times
upsets me. In the modern age of {*filter*} we have so many new good ones for
local, spinal and epidural anesthesia the type of surgery that someone has
should be the only limiting factor as to the type of anesthesia they have
but every day we put people to sleep because the prefer it to a safer
method.  

I too had a very bad experience in the dentis office as a child and fortunatly
have gotten over it. I woun't dare let a dentis put me to sleep but not
because I don't think some of them are good at it but because I don't think
it is necessarey. I can stand a little pain and I don't mind having my jaw
asleep for the rest of the day. It beats the pain you have right after the
dentist work when the N2O wears off.

Ann S. Williams CRNA



Thu, 29 Oct 1992 19:24:05 GMT
 True facts about nitrous oxide


Fri, 19 Jun 1992 00:00:00 GMT
 True facts about nitrous oxide

Quote:
> Contrary to my origine system I am a nurse anesthetist. Nigel, the facts
[line deleted]
> some anesthesia personal. We have good ones and bad ones. The dentist who
> have had training in N2O admistration should be competent to give it.

What you're missing here is the fact that the dentist may be quite
competent to give anesthesia, but he's got dentistry to do also.  You
don't often see surgeons running the gas with one hand while they cut
with the other...

My dentist decided that it was too dangerous and got rid of his NO2
equipment.  He now uses some spray anesthetic prior to using the
needle to inject novocaine.  Works pretty well even if it does taste
like bananas.
--
               | 'shasha', the word for 'senile', meant not just old
Ed Clarke      | and weak-minded, but also implied impotence, incontinence,
acheron!clarke | coprophagic habits and a tendency to indulge in a desire
               | to practice {*filter*} on dead sheep.  Among other things.



Fri, 30 Oct 1992 11:00:30 GMT
 
 [ 5 post ] 

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