Nitrous Oxide for pain procedure anxiolysis and analgesia, thoughts?

[Ligament]

I understand many do not offer sedation for pain procedures. For those that do, what are your thoughts on patient controlled Nitrous Oxide?

This machine looks interesting:
PRO-NOX™ Medical Nitrous Oxide Sedation System | CAREStream America

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Members don't see this ad.

 

[willabeast]

used something similar o.b. better than nothing, but not much.

 

[lonelobo]

Funny stuff

 

[Gauss]

l have always liked the idea, great anxiolysis and can drive home once it wears off. Never acquired it due to fire code restrictions in building (flammable). Not sure how to apply if patient is prone

 

[Ligament]

Bump. I know at least one SDN member has this machine now. Anybody else incorporate Nitrous into in-office procedures now?

 

[hyperalgesia]

I'm also interested in this. I like the idea.

 

[Ligament]

Do the anesthesiologists on this forum have any objections to using nitrous in the pain clinic, assuming the patient has no contraindications?

 

[NJPAIN]

I used it rarely for an adult with needlephobia to place an IV in the OR. 50% via face mask held by the patient. 50% did well and 50% got a little combative. I’ve never heard anything good about it’s use in L&D. In any setting, especially one not supervised by an anesthesiologist, you need a system that won’t allow delivery of a hypoxic mixture. I also think it is safest to have patient self administer by holding mask to face rather than attaching it to the face.
I’d be interested to hear how it is working for procedural sedation/analgesia.

 

[gdub25]

We use nitrous every week in our clinic. We don’t promote it, just use it on patients who feel like they need something and it’s more of a customer service deal than anything. We charge them $75 for it and most patients are more than happy to pay. Everyone in my group is an anesthesiologist and we had no issues with using it in an office setting. We bought a portable dental machine used off of the website and it works fine. We called the state code office as well as medical board and there were no regulations or licensing that we had to do, it was as easy as buying machine starting to use it on day one. We now use it on all of our kyphoplasty’s and it works pretty good for that.

 

[NJPAIN]

We use nitrous every week in our clinic. We don’t promote it, just use it on patients who feel like they need something and it’s more of a customer service deal than anything. We charge them $75 for it and most patients are more than happy to pay. Everyone in my group is an anesthesiologist and we had no issues with using it in an office setting. We bought a portable dental machine used off of the website and it works fine. We called the state code office as well as medical board and there were no regulations or licensing that we had to do, it was as easy as buying machine starting to use it on day one. We now use it on all of our kyphoplasty’s and it works pretty good for that.

Are you using that dental nose mask thing?

 

[Ligament]

For those experienced with it; what is the ratio of analgesia/anxiolysis you typically see with a self-administered, patient-held interface system?

 

[gdub25]

We started with the dental nose mask but now we just use a traditional Anesthesia circuit with a facemask on it. it’s way more convenient with that because they put their face in the hole in the table and the face mask fits in there around their nose and mouth from the bottom.

I haven’t seen the patient administered apparatuses, we just crank them to 70% nitrous and do the procedure really quick. The one thing we were worried about was nausea and vomiting but our procedures are so fast that I don’t think they have enough time to get this affect. We haven’t seen one episode of it.

I will say that the amount of sedation they get out of this is not very reliable at all. Some patients fall asleep completely and don’t budge when we do the procedure and others are looking over their shoulder at me saying “hey Doc, when’s this stuff going to kick in”. Overall it’s been a decent deal for us, it cost us about $3000 to get set up and we’ve made our money back by now.

 

[Aether2000]

Since any whiff of nitrous causes me massive headaches for the rest of the day, I do not use nitrous on any patient anywhere.

 

[lobelsteve]

Just go with an iSi unit. Cartridges at Williams Sonoma.

 

[drusso]

For those experienced with it; what is the ratio of analgesia/anxiolysis you typically see with a self-administered, patient-held interface system?

It's mostly anxiolysis. Since 95% of what we do doesn't require sedation at all it's perfect for the moderately anxious patient. Very pleased with it. For those in more of a concierge/direct care independent setting, it is a great customer service/altered comfort adjunct.

 

[lobelsteve]

It's mostly anxiolysis. Since 95% of what we do doesn't require sedation at all it's perfect for the moderately anxious patient. Very pleased with it. For those in more of a concierge/direct care independent setting, it is a great customer service/altered comfort adjunct.

Heck, id come by for some prp if i got free whippets.

 

[drusso]

Heck, id come by for some prp if i got free whippets.

They come for the platelets but they stay for the whippets.

 

[callmeanesthesia]

They come for the platelets but they stay for the whippets.

Then you can sell them B12 shots after a few procedures too.

 

[drusso]

Then you can sell them B12 shots after a few procedures too.

I did start taking B12 vitamins after we installed the nitrous...Just in case.

 

[geauxg8rs]

I did start taking B12 vitamins after we installed the nitrous...Just in case.

Just make sure you avoid gluten for 72 hours so you don’t get a fibro flare