Nitrous oxide may be considered to be the most popular form of sedation among pediatric dentists. It has earned this place due to its excellent safety record and ease of use. It provides rapid onset and offset of sedation. Because of its unique inhalation application, it has been allocated to this chapter, separate from other pharmacologic agents. The mechanisms of its action have been discussed and its practical administration described in detail.
Nitrous oxide is a gas with anxiolytic and sedative effects combined with varying degree of analgesia and muscular relaxation. Recent research suggest that both GABA a and NMDAreceptors are affected by nitrous oxide . Nitrous oxide when administrated to patients for inhalation must be given in a mixture with oxygen (30% or more) to safeguard the patient’s oxygen supply. Nitrous oxide is non-irritant to the respiratory tract, has a low tissue solubility, and a minimum alveolar concentration (MAC) value of more than one atmosphere. Therefore nitrous oxide has a rapid onset, a fast recovery (both within minutes) and is a poor anaesthetic.
Nitrous oxide (N2O) is an invaluable tool in managing the mild to moderately anxious child. Its ease of admini stration, wide margin of safety, analgesic and anxiolytic effects, and, most of all, its rapid reversibility make it an ideal drug for use in children (PatersonTahmassebi 2003; Houpt 2004). The American Academy of Pediatric Dentistry (AAPD), among other organizations, recognizes nitrous oxide/oxygen inhalation
sedation as a safe and effective technique to reduce anxiety, produce analgesia, and enhance effective communication between a patient and health care provider (AAPD 2012). However, clinicians should not make the mistake of thinking that N2O sedation by itself controls behavior. Nitrous oxide serves as an adjunct to behavior management.