Published online February 29, 2008
PEDIATRICS Vol. 121 No. 3 March 2008, pp. e528-e532 (doi:10.1542/peds.2007-1044)
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ARTICLE

High-Concentration Nitrous Oxide for Procedural Sedation in Children: Adverse Events and Depth of Sedation

Franz E. Babl, MD, MPH, Ed Oakley, MBBS, Cameron Seaman, MBBS, Peter Barnett, MBBS, MSc and Lisa N. Sharwood, RN, BN, MPH

Emergency Department, Royal Children's Hospital, Murdoch Children's Research Institute and University of Melbourne, Melbourne, Australia

OBJECTIVE. Nitrous oxide is an attractive agent for procedural sedation and analgesia in the emergency department; however, there are limited safety data for high-concentration continuous-flow nitrous oxide (50%–70%) and its use in young children. We set out to characterize the depth of sedation and incidence of adverse events associated with various concentrations of nitrous oxide used in a pediatric emergency department.

METHODS. This was a prospective observational study of nitrous oxide use for procedural sedation and analgesia in a tertiary children's hospital emergency department. Nitrous oxide concentration, adverse events, and sedation depth were recorded. Adverse events were categorized as mild or serious. Sedation depth was recorded on a sedation scale from 0 to 6.

RESULTS. A total of 762 patients who were aged 1 to 17 years received nitrous oxide during the 2-year study period. A total of 548 (72%) received nitrous oxide 70%, and 101 (13%) received nitrous oxide 50%. Moderate or deep sedation with scores of ≤2 occurred in 3% of patients who had received nitrous oxide 70% and no patients who had received nitrous oxide 50%. Mean sedation scores were 4.4 at nitrous oxide 70% and 4.6 at nitrous oxide 50%. Sixty-three (8.3%) patients sustained 70 mild and self-resolving adverse events, most of which were vomiting (5.7%); 2 (0.2%) patients had serious adverse events. There was no significant difference in adverse events rates between nitrous oxide 70% (8.4%) and nitrous oxide 50% (9.9%). There was no significant difference in the percentage of deep sedation when children who were ≤3 years of age (2.9%) were compared with older children (2.8%).

CONCLUSIONS. In this largest prospective emergency department series, high-concentration continuous-flow nitrous oxide (70%) was found to be a safe agent for procedural sedation and analgesia when embedded in a comprehensive sedation program. Nitrous oxide also seems safe in children aged 1 to 3 years.

Key Words: nitrous oxide • procedural sedation and analgesia • adverse events • emergency department

Abbreviations: N2O—nitrous oxide • ED—emergency department • PSA—procedural sedation and analgesia • O2—oxygen • IQR—interquartile range • CI—confidence interval

Accepted Jul 19, 2007.