Nitrous oxide analgesia for minor pediatric surgical procedures: an effective alternative to conscious sedation?J Pediatr Surg 2004; 39(3):495-9; discussion 495-9JP
Minor surgical procedures in children, while usually not requiring general anesthesia, need effective control of pain, anxiety, and motion. Certain techniques of conscious sedation may result in loss of protective airway reflexes. Nitrous oxide, however, when inhaled at levels below 50% maintains protective reflexes and does not require fasting or postprocedure monitoring. This study prospectively examines the efficacy of nitrous oxide analgesia in children undergoing outpatient surgical procedures.
Over a 2-year period (2000 to 2002), 150 consecutive children were given nitrous oxide analgesia as an alternative to a general anesthetic, sedation, or local anesthetic alone. Nitrous oxide (<50%) was administered by our practice's sedation-certified nurse practitioner without an anesthesiologist present. The children used the Wong-Baker Faces Scale (0-5) to score pain at different intervals (preprocedure, at injection, during procedure, and postprocedure) and event memories were tabulated.
Of 150 children, 5 were uncooperative and could not participate. One hundred forty-five children, ages 1 to 20 years (Mean, 9.83 +/- 4.92 years) successfully underwent procedures (58 cyst/nevus excisions, 49 abscess drainages, 38 other) using nitrous. Two patients were too young to score pain. Pre- and postprocedure pain scores were significantly higher in the abscess group (P <.0001); during the procedures, however, all groups reported pain scores less than 1, with parents citing 100% satisfaction with the technique. Of 128 children receiving local anesthesia, 107 (84%) had no recall of the injection. Complications were limited to 4 patients; 2 experienced nausea, and 2 vomited. All resolved without interrupting the procedure.
Nitrous oxide analgesia is a cost-effective and efficacious alternative to conscious sedation or general anesthesia for minor pediatric surgical procedures. In the office or outpatient setting, the technique provides for almost pain/anxiety-free surgery, no postoperative monitoring, and a high degree of satisfaction for patients, parents, and staff.