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What is the main cause for minimal contamination of N2O in a dental office? ✔Correct
Answer-possible answers: nasal hood not fitting properly, leaking hoses, scavenger system not
being used right, or even could be patient talking and releasing nitrous into the air.
What are the effects of over-sedation? ✔Correct Answer--The patient should be told to signal
or tell the operator if they become uncomfortable.
-Signs of agitation by being restless/fidgety.
-The patient may begin dreaming or hallucinating.
-Eyes become heavy/fixed, may close
-Mouth breathing.
-Uncontrolled laughter.
-Dizziness, lightheaded, nausea, vomiting.
-Patient may become too warm.
-Speech may become slurred.
-Patient could become unconscious.
If a patient was given 60% N2O and is suddenly taken off N2O, what could happen? ✔Correct
Answer-diffusion hypoxia
How is diffusion hypoxia treated? ✔Correct Answer-diffusion hypoxia-lack of O2 following
sedation, "hungover" feeling: headache, grogginess, nausea.
Know the two major muscles used for breathing. ✔Correct Answer-
How does N2O react with the respiratory system? ✔Correct Answer-
Can N2O be used on a patient with emphysema? ✔Correct Answer-It is important to check
with the patient's physician prior to administer N2O if they have COPD or emphysema.
What profession has the highest % of N2O abuse? ✔Correct Answer-DDS then DH
What does tidal volume mean? ✔Correct Answer-
What medication should NOT be used for pain after the patient has been on N2O? ✔Correct
Answer-There aren't any pain meds that cannot be used because as soon as nitrous is off and 5
minutes with oxygen, the drug is pretty much out of the system, and there are very few
contraindications other drugs anyways.
, DURING nitrous sedation, opioids could depress the CVS in conjunction with nitrous, but
shouldn't be a problem unless a person has congestive heart failure.
Know how the N2O procedure is completed/finished. ✔Correct Answer-N2O is completed
with turning off nitrous and turning oxygen up to tidal volume for five minutes or longer if
needed.
If the patient becomes nauseated while on N2O, should you reduce the N2O or stop it?
✔Correct Answer-Stop it and put the patient on 100% Oxygen
Know what titration means and how it is achieved. ✔Correct Answer-method of
administering a drug in incremental amounts until a desired endpoint is reached, using the least
amount of drug possible to achieve patient comfort. How?
How much of N2O is excreted through the lungs? ✔Correct Answer-Just about all of it, 99%.
The rest is eliminated through the skin.
If the bag collapses when the patient is using the nasal hood, what is happening: not enough
gas is being given or the patient needs a new nasal hood? ✔Correct Answer-
If a person becomes restless during N2O, what should you do, tell them to relax or decrease the
N2O? ✔Correct Answer-Reduce N2O because they should be relaxed naturally and it means
they may be getting too much nitrous gas.
What happens to vital signs (BP, Pulse, Respiration) under minimal sedation? ✔Correct
Answer-There should be no changes in vital signs under minimal sedation
Who must be asked to give permission for a pregnant woman to receive N2O, her physician, a
DDS, or the dental hygienist? ✔Correct Answer-The physician must be contacted prior to
administering N2O to a pregnant patient. N2O does cross the placenta barrier.
Know what N2O is absorbed through: nerve, bone, or tissue? ✔Correct Answer-N2O is
absorbed through tissue- alveoli transferred over to the bloodstream then to the brain.
Know the medical conditions that N2O is contraindicated for, and which are not. ✔Correct
Answer-No absolute medical contraindications, only precautions:
-Pregnancy (especially during 1st trimester).
-Communication barrier.
-Nasal obstruction.
-COPD.
-Cystic fibrosis.
-Emotional/mental instability.
-Epilepsy - can trigger a seizure.
-Negative past experience with N2O.