Nitrous Oxide for pain procedure anxiolysis and analgesia, thoughts?

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Ligament

Ligament

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used something similar o.b. better than nothing, but not much.
 
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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
 
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.
 
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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.
 
gdub25 said:
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.
Click to expand...

Are you using that dental nose mask thing?
 
For those experienced with it; what is the ratio of analgesia/anxiolysis you typically see with a self-administered, patient-held interface system?
 
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.
 
Since any whiff of nitrous causes me massive headaches for the rest of the day, I do not use nitrous on any patient anywhere.
 
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Ligament said:
For those experienced with it; what is the ratio of analgesia/anxiolysis you typically see with a self-administered, patient-held interface system?
Click to expand...

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.
 
drusso said:
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.
Click to expand...

Heck, id come by for some prp if i got free whippets.
 
Just wanted to bump this thread back up. Any updated feedback on experiences with this? Any recommendations on which system to buy?
 
We still use it everyday, no issues. Got all of ours from atlas medical website. Used dental supplier.
 
Used my setup probably about 10x before changing cylinders which is the best I have ever done. Had a trial that was not going to make it through that I deployed the nitrous on and it made all of the difference.
 
What’s the per patient cost for the average setup? I’ve been considering this as I don’t offer any in office sedation other than PO.
 
I think it probably costs at least $60 per patient. E cylinders don’t last that long and aren’t cheap. I use a disposable circuits and masks which increase the costs. But if you look at the dental setups they are impossible
to clean with anything we have in our offices. They either don’t clean them at the dentist or soak them and then blow them out with pressurized air as the tubing is quite small and would retain water.
 
BobBarker said:
I think it probably costs at least $60 per patient. E cylinders don’t last that long and aren’t cheap. I use a disposable circuits and masks which increase the costs. But if you look at the dental setups they are impossible
to clean with anything we have in our offices. They either don’t clean them at the dentist or soak them and then blow them out with pressurized air as the tubing is quite small and would retain water.
Click to expand...
Are you allowed to charge extra for this for mcare pts?
 
We also don't charge for it for kypho and I agree that at charging $75 a patient, we definitely aren't making any money.
 
I use pronox. Up front investment but cost per case without that taken into account is about 20/case I think. Charge cash with a margin. Pretty sure it's paid off and profitable now.
 
Someone on the forum once posted this link to a medication they give prior to procedure/SCS.



Anyone have experience?

Midazolam 3mg, Ketamine HCl 25mg and Ondansetron 2mg
1EA troches
21 units per Box

Imprimis RX

www.imprimisrx.com www.imprimisrx.com
 
Malayil said:
Someone on the forum once posted this link to a medication they give prior to procedure/SCS.



Anyone have experience?

Midazolam 3mg, Ketamine HCl 25mg and Ondansetron 2mg
1EA troches
21 units per Box

Imprimis RX

www.imprimisrx.com www.imprimisrx.com
Click to expand...
Why would you do something so complicated when giving him a benzo will do the same thing and is way more common. If not, just use sedation like the majority of folks would do.
 
lobelsteve said:
Why would you do something so complicated when giving him a benzo will do the same thing and is way more common. If not, just use sedation like the majority of folks would do.
Click to expand...
I might be wrong but my understanding is that nitrous is preferred in some patients with a history of substance issues, like with benzodiazepines, alcohol, opioids. People will point out nitrous has potential for home abuse but anyway
 
lobelsteve said:
Why would you do something so complicated when giving him a benzo will do the same thing and is way more common. If not, just use sedation like the majority of folks would do.
Click to expand...
Speed of recovery, easier titration and less risk of falls at home
Quick on and quick off.

IV holds up a room for me and I don’t have recovery bay
 
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