Nitrous Oxide Reduces Anxiety in Children Undergoing Painful Procedures
Nitrous given by non-anaesthesia trained personnel. Note the high incidence of vomiting and nearly 10% incidence of desaturation that is acceptable ("few adverse incidents") in this report. Alan Klein, MD
LONDON (Reuters Health) Jun 28 - In addition to relieving pain, nitrous oxide appears to alleviate anxiety in children during painful procedures.
Dr. S. A. Kanagasundaram, now at The Whittington Hospital in London, and colleagues at a children's hospital in Australia examined the effects of nitrous oxide on 90 children undergoing lumbar puncture, venous cannulation, bone marrow aspiration, or a dressing change. Nitrous oxide was administered by a nurse as trained observers watched for signs of pain and anxiety, such as crying and flailing.
Overall, scores on the Observational Scale of Behavioral Distress-Revised increased during nitrous oxide induction and subsequently decreased during preparation for and administration of the painful procedure.
The increased score during induction "could be caused by numerous factors, including the application of the mask and nitrous oxide inhalation [as well as] anticipation of the procedure and parental separation," the investigators speculate in the June issue of Archives of Disease in Childhood. "The subsequent reduction in distress score [demonstrates] that continuous nitrous oxide administration decreases the level of distress to a minimal level."
Few side effects were noted. Only 7.8%, 4.4% and 2% of children, respectively, experienced vomiting, excitement or dysphoria in response to nitrous oxide administration, and none developed hypoxia, airway obstruction or aspiration. Eight of the 90 patients developed oxygen desaturation. On average, children completely recovered within 3 minutes.
The authors note that nitrous oxide was particularly effective in children age 6 and older, who showed lower levels of distress than younger children during induction.
Nitrous oxide's "most appropriate application is to children over the age of 6 and for short procedures," the researchers conclude. "The low incidence of adverse effects and short recovery time in unpremedicated children allow safe administration by non-anesthetists outside the operative theatre."
Arch Dis Child 2001;84(6):492-495
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