Elsevier

Archives de Pédiatrie

Volume 6, Issue 8, August 1999, Pages 844-848
Archives de Pédiatrie

Mémoire original
Utilisation du mélange équimolaire oxygène-protoxyde d'azote dans un service de pédiatrie généraleUse of 50% oxygen-nitrous oxide mixture in a general pediatric ward

https://doi.org/10.1016/S0929-693X(00)88477-8Get rights and content

Résumé

Objectif

Rapporter l'expérience de l'utilisation du mélange équimolaire d'oxygène et de protoxyde d'azote (MEOPA) dans un service de pédiatrie générale.

Patients et méthode

Il s'agit d'une étude longitudinale: du 1er avril 1997 au 31 mars 1998, tous les enfants devant subir des gestes ou des soins douloureux ont bénéficié de l'inhalation du MEOPA. La douleur, l'agitation et les effets secondaires ont été notés.

Résultats

Cent vingt-sept gestes ont été réalisés sous MEOPA chez 90 enfants dont 61 garçons. Ils étaient âgés de 5 mois à 15 ans (moyenne: 5,7 ans; médiane: 4,1 ans). Les indications étaient: ponction lombaire (n = 45), soins de brûlure (n = 29), pose de voie veineuse (n = 12), petite chirurgie (n = 27), divers (n = 14). La durée d'inhalation a été de 2 à 70 min (moyenne: 14,4 min; médiane: 11 min). La douleur était absente ou faible dans 106 cas (83,4 %). L'agitation était nulle ou faible dans 100 cas (78,8 %). Des effets secondaires, toujours peu intenses et rapidement réversibles, ont été observés 12 fois.

Conclusion

Le MEOPA semble pouvoir être proposé dans un service de pédiatrie générale. D'autres études sont nécessaires afin de définir les meilleures indications.

Summary

We report our experience of the utilization of the 50% oxygen-nitrous oxide mixture (nitrous oxide 50%) in our general pediatric ward after one year of use.

Patients and methods

Between 1st April 1997 and 31st March 1998, children who had to undergo a painful procedure were proposed to inhale 50% nitrous oxide before the procedure. We evaluate pain, restlessness and adverse effects.

Results

The procedures (127 of them) were carried out in 90 children (61 boys). They were aged from 5 months to 15 years (mean: 5.7 years; median: 4.1 years). Indications were: lumbar puncture (n = 45), burning dressing (n = 29), venous cannulation (n = 12), minor surgery (n = 27), and miscellaneous (n = 14). Inhalation time was between 2 to 70 min (mean: 14.4 min; median: 11 min). Pain was absent or low in 106 cases (83.4%). Restlessness was absent or low in 100 cases (78.8%). Averse events were observed 12 times, but they were always minor and quickly reversible.

Conclusion

Nitrous oxide (50%) can be used successfully in a general pediatric ward. Other studies are necessary to define the best conditions.

Références (15)

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  • The Efficacy of Premixed Nitrous Oxide and Oxygen for Fiberoptic Bronchoscopy in Pediatric Patients: A Randomized, Double-Blind, Controlled Study

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    In addition, the tolerance of premixed 50% nitrous oxide and oxygen was excellent with only minor side effects observed. Premixed 50% nitrous oxide and oxygen has been proposed to provide sedation and analgesia in a large variety of pediatric procedures, including lumbar puncture, bone marrow aspiration, laceration repair, dressing changes, various diagnostic punctures, and dental care.89101516 However, to our knowledge, the efficacy of premixed 50% nitrous oxide and oxygen has been investigated in the pediatric population in only one randomized controlled trial.16

  • Nitrous oxide exerts age-dependent antinociceptive effects in Fischer rats

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    This should be borne in mind when administering general anesthesia to the very young during painful procedures; supplementation of N2O with another analgesic agent appears prudent. To date many investigators have reported on the usefulness of N2O/O2 mixture (most often 50%/50% combination) to provide relief to children during so-called ‘procedure pain’, e.g. dental treatment (Shapira et al., 1992; Primosch et al., 1999), venous cannulation (Henderson et al., 1990; Vetter, 1995; Paut et al., 2001), laceration repair (Gamis et al., 1989; Burton et al., 1998; Luhmann et al., 2001), gastrointestinal endoscopy (Michaud et al., 1999), reduction of factures (Evans et al., 1995; Hennrikus et al., 1995), and other painful procedures (Vic et al., 1999). In addition to the concern that it may be difficult to establish that analgesia is occurring in the presence of the prominent hypnotic action of N2O in the very young, most of the subjects in the above-mentioned studies were not neonates.

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