Home Drug Guide Nitrous Oxide

Drug Guide

Generic Name

Nitrous Oxide

Brand Names Nitrous Oxide, USP

Classification

Therapeutic: Analgesic and Sedative

Pharmacological: Inhalational anesthetic and analgesic

FDA Approved Indications

  • Short-term dental procedures
  • Intraoperative and postoperative analgesia and anesthesia

Mechanism of Action

Nitrous oxide acts on the central nervous system, producing analgesia and anesthesia primarily through modulation of neuronal ion channels, including NMDA receptors, and increasing endogenous opioid activity.

Dosage and Administration

Adult: Typically, inhaled at concentrations of 30-70% mixed with oxygen, titrated to effect.

Pediatric: Doses tailored based on age, weight, and procedural requirements, generally similar concentration ranges as adults.

Geriatric: Use with caution; start at lower concentrations due to increased sensitivity and comorbidities.

Renal Impairment: No specific dose adjustment; however, renal function should be monitored in prolonged use.

Hepatic Impairment: No specific dose adjustment, but caution advised as hepatic metabolism of some components occurs.

Pharmacokinetics

Absorption: Rapid absorption through the alveoli, providing quick onset of action.

Distribution: Well distributed throughout the body, including the central nervous system.

Metabolism: Minimal metabolism; most nitrous oxide is exhaled unchanged.

Excretion: Exhaled unchanged via the lungs.

Half Life: Approximately minutes, given its rapid onset and recovery.

Contraindications

  • Patients with pneumothorax, bowel obstruction, middle ear blockages, or any condition where increased air pressure may be hazardous.
  • Previous adverse reactions to nitrous oxide.

Precautions

  • Use with caution in patients with COPD, vitamin B12 deficiency, or neurological disorders.

Adverse Reactions - Common

  • Nausea or vomiting (Common)
  • Dizziness (Common)
  • Sedation (Common)

Adverse Reactions - Serious

  • Depression of ventilation or consciousness (rare) (Rare)
  • Psychological reactions such as anxiety or hallucinations (rare) (Rare)
  • Myelopathy due to vitamin B12 deficiency (with prolonged exposure) (Rare)

Drug-Drug Interactions

  • Potential potentiation with other CNS depressants including opioids, benzodiazepines.
  • Vitamin B12 antagonists or deficiencies may increase risk of neurological effects.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Assess baseline mental status, respiratory function, and allergies.

Diagnoses:

  • Risk for injury related to dizziness or hallucinations.
  • Impaired gas exchange.

Implementation: Monitor vital signs and level of consciousness during administration. Ensure proper delivery equipment and scavenging systems.

Evaluation: Assess pain relief, patient comfort, and any adverse reactions.

Patient/Family Teaching

  • Inform about the sensation of euphoria or tingling.
  • Report any dizziness, nausea, or unresponsiveness.
  • Advise postoperative monitoring if applicable.

Special Considerations

Black Box Warnings:

  • Potential for asphyxiation if improperly administered or with inadequate scavenging.
  • Risks associated with misuse or overuse.

Genetic Factors: No specific genetic factors identified.

Lab Test Interference: Minimal, but prolonged exposure may affect vitamin B12 levels or methylmalonic acid tests.

Overdose Management

Signs/Symptoms: Loss of consciousness, respiratory depression, hypoxia.

Treatment: Administer 100% oxygen, support ventilation, and monitor vital signs. Remove exposure source.

Storage and Handling

Storage: Store in a cool, dry, well-ventilated area in a tightly sealed container.

Stability: Stable under recommended storage conditions.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.