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  • Patient refusal

  • Communication difficulties

  • Inability to use nasal mask - unable to breathe through nose

  • Conditions where gas expansion could occur such as middle ear infection , sinusitis, recent inner ear surgery

  • Latex allergy when latex bags are used

Nitrous Oxide Sedation

Absolute Contraindications
Relative Contraindications

  • Drug or alcohol abuse - patient may be seeking euphoric rather anxiolytic effect

  • Previous negative experience

  • COPD/Emphysema

    • Avoid with severe COPD

    • Avoid in patients that retain carbon dioxide

    • Avoid if patient is experiencing difficulty breathing

  • Psychiatric disorders/psychiatric medications

    • OK for use with personality or psychiatric disorders

    • In schizophrenia, bipolar or moderate to severe mental delay there may be unpredictable results

  • Asthma

    • OK to use unless patient is having an attack. 

  • Pregnancy

    • Avoid if possible during the pregnancy

    • Use is OK in any trimester in emergency situation and patient is highly anxious

    • Use for 30 minutes or less wityh no less than 50% oxygen at all times.

  • Sickle cell disease

    • Use with 50% oxygen at all times

Benefits of Nitrous Oxide Sedation 

  • Analgesic effect

  • Anxiolytic effect - for stress reduction

  • Concurrent delivery of oxygen - in medically compromised patient

  • Rapid onset of action and peak clinical effect

  • Rapid reversal of sedation

  • Ability to titrate

  • "Nothing by mouth" (NPO) not required

  • No escort necessary - patient can safely drive to and from appointment

  • No venipuncture required

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