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Nitrous oxide-oxygen inhalation for outpatient otologic examination and minor procedures performed on the
Gadi Fishman1, Eyal Botzer, Nisim Marouani
1Pediatric Otolaryngology Unit, Dana Children's Hospital, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, 6 Weizmann St., Tel-Aviv 64239, Israel. nognet@sbcglobal.net
Insights
Nitrous oxide-oxygen inhalation effectively sedated uncooperative children during otologic exams and procedures, reducing pain and anxiety. This method proved safe and successful, avoiding the need for physical restraint and general anesthesia.
Area of Science:
- Pediatric Otolaryngology
- Pain Management
- Sedation Techniques
Background:
- Otomicroscopic examinations and minor procedures can cause significant discomfort, anxiety, and pain in children.
- Lack of cooperation during these procedures can lead to ear trauma, delayed diagnosis, and the need for general anesthesia.
Purpose of the Study:
- To evaluate the efficacy and safety of nitrous oxide-oxygen inhalation for sedation and analgesia.
- To assess its utility in otologic examinations and minor surgical procedures for uncooperative children in an outpatient setting.
Main Methods:
- A prospective pilot case series was conducted in a Pediatric Otolaryngology outpatient clinic.
- Nitrous oxide-oxygen inhalation was administered by the otolaryngologist and nurse to children over 2 years old.
- Inclusion criteria focused on children unable to tolerate procedures due to anxiety and lack of cooperation.
Main Results:
- Procedure completion was successful in 88% (21/24) of patients.
- Full cooperation, without the need for restraint, was achieved in 83% (20/24).
- Mean pain scores were in the mild range, with one instance of vomiting as an adverse reaction.
Conclusions:
- Nitrous oxide-oxygen inhalation is a potentially useful sedation method for outpatient otologic procedures.
- It effectively alleviates pain and anxiety, minimizing the need for physical restraint.
- This technique offers a promising alternative to general anesthesia for uncooperative children.
Objective:
Otomicroscopic examination with suctioning of ears or other procedures is frequently uncomfortable especially for children. Anxiety and pain with lack of cooperation may result in trauma to the ear, incompletion of the examination, delayed diagnosis and treatment and need for completion of the examination under general anesthesia. The purpose of this study was to evaluate the efficacy and safety of utilizing nitrous oxide-oxygen inhalation for sedation and analgesia in otologic examination and minor surgical procedures performed on the uncooperative child at the outpatient clinic.
Methods:
In a prospective pilot case series study conducted at the Pediatric Otolaryngology outpatient clinic of a tertiary medical center, nitrous oxide-oxygen inhalation was administered by the examining otolaryngologist and the assisting nurse. The study group included children over 2 years old, for which an accurate diagnosis of ear pathology could not be made or a minor surgical procedure could not be tolerated because of anxiety and lack of cooperation.
Results:
Completion of the indicated procedure was successful in 21 of 24 patients (88%). Full cooperation, where no restraint was necessary was achieved in 20 of 24 patients (83%). The mean rank pain scores, evaluated separately by the patient, parent and staff, were in the mild pain range using a 0-10 coding for Faces Pain Rating Scale. The mean procedure time was 8.9 min. An adverse reaction, vomiting, occurred in one patient. Twenty-one of 24 parents stated that they would repeat the procedure if necessary.
Conclusion:
This pilot study shows the potential usefulness of nitrous oxide-oxygen inhalation administered by an otolaryngologist in the outpatient clinic. Alleviation of pain and anxiety and avoiding the need for physical restraint is an important goal that can be achieved with this form of sedation.
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