ORIGINAL ARTICLE

Nurse administered relative analgesia using high concentration nitrous oxide to facilitate minor procedures in children in an emergency department

A Frampton, G J Browne, L T Lam, M G Cooper, L G Lane

Departments of Emergency Medicine, Anaesthetics, and the Pain and Palliative Care Service, The Children’s Hospital at Westmead, Sydney, Australia

Correspondence to:
Correspondence to:
Dr G J Browne, Department of Emergency Medicine, The Children’s Hospital at Westmead, Cnr Hawkesbury Road and Hainsworth Street, Westmead NSW 2045, Sydney, Australia;
Garyb{at}chw.edu.au

Aims: To describe the experience of using high concentration nitrous oxide (N₂O) relative analgesia administered by nursing staff in children undergoing minor procedures in the emergency department (ED) and to demonstrate its safety.

Method: Data were collected over a 12 month period for all procedures in the ED performed under nurse administered N₂O sedation. All children greater than 12 months of age requiring a minor procedure who had no contraindication to the use of N₂O were considered for sedation by this method. The primary outcome measure was the incidence of a major complication namely respiratory distress or hypoxia during the procedure. Secondary outcome measures were minor complications and the maximum concentration of N₂O used.

Results: Data were collected for a total of 224 episodes of nurse administered N₂O sedation over a 12 month period. In 73.2% of children no complications were recorded. One major complication was recorded (respiratory distress) and the most common minor complication was mask intolerance in 17%. The mean maximum concentration of N₂O used was 60.2%.

Conclusions: N₂O is a safe analgesic in children over the age of 1 year undergoing painful or stressful procedures in the ED. It may safely be administered in concentrations of up to 70% by nursing staff after appropriate training.

Keywords: analgesia; nitrous oxide; nursing; children

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Primary Survey

Pete Driscoll, Jim Wardope
Emerg. Med. J. 2003 20: 397. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Babl, F E, Oakley, E, Puspitadewi, A, Sharwood, L N (2008). Limited analgesic efficacy of nitrous oxide for painful procedures in children. Emerg. Med. J. 25: 717-721 [Abstract] [Full Text]  
• Babl, F. E., Oakley, E., Seaman, C., Barnett, P., Sharwood, L. N. (2008). High-Concentration Nitrous Oxide for Procedural Sedation in Children: Adverse Events and Depth of Sedation. Pediatrics 121: e528-e532 [Abstract] [Full Text]  
• Zier, J. L., Drake, G. J., McCormick, P. C., Clinch, K. M., Cornfield, D. N. (2007). Case-Series of Nurse-Administered Nitrous Oxide for Urinary Catheterization in Children. Anesth. Analg. 104: 876-879 [Abstract] [Full Text]  
• American Academy of Pediatrics, , American Academy of Pediatric Dentistry, , Cote, C. J., Wilson, S., the Work Group on Sedation, (2006). Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures: An Update. Pediatrics 118: 2587-2602 [Abstract] [Full Text]  
• Howes, M C, Browne, G J, Frampton, A, Lam, L T, Cooper, M G, Lane, L G (2004). What is "relative analgesia?" * Authors' reply. Emerg. Med. J. 21: 646-647 [Full Text]  
• Perrin, J (2003). Working together, sharing the burden. Emerg. Med. J. 20: 398-398 [Full Text]  

eLetters:

Read all eLetters

What is "relative analgesia?"

Marten C Howes

EMJ Online, 1 Oct 2003 [Full text]

What is "relative analgesia"? Reply

Gary J Browne, et al.

EMJ Online, 17 Nov 2003 [Full text]