Current status of nitrous oxide use in pediatric patients

Table 4 Summary of various trials on use of nitrous oxide for alleviation of procedural pain and sedation in children

Ref.	Main study objective	Setting/procedures	Number of children; Age	Findings
Babl et al[43], 2008	Depth of sedation and incidence of adverse effects with various N2O concentrations	Pediatric ER procedures	762; 1-17 yr	N2O in high concentration (70%) and continuous flow was found to be a safe agent for procedural sedation and analgesia in toddlers and older children
Babl et al[44], 2010	Sedation practices and the associated adverse events profile	Procedural sedation and analgesia from registry database at the largest Australian pediatric ER of a children’s hospital	2002; 1-17 yr	N2O was used in majority cases (81%), and incidence of serious adverse events was low. (desaturation, n = 2; seizures, n = 2, and chest pain, n = 1)
Brown et al[45], 2009	Evaluate the PediSedate (a N2O delivery system combined with an interactive video component) for reducing children’s behavioral distress	Children who received the PediSedate before invasive procedures	40; 3-9 yr	PediSedate is an effective system for procedural sedation in children
Ekbom et al[46], 2011	To find out whether oral midazolam or 50% N2O, or 10% N2O; along with lidocaine/prilocaine ointment is most effective in gaining IV access in obese or growth retarded children	Children and adolescents undergoing IV access at a Children’s Hospital in Stockholm, Sweden	90; 5-18yr	50% N2O resulted in an improved rate of IV access, a shorter procedure time, and a better experience for these children
Jimenez et al[47], 2012	Comparison of N2O and hematoma block with and without trans-mucosal fentanyl for sedation and analgesia in the reduction of radioulnar fractures.	Retrospective, observational study, in children with radioulnar fractures in a pediatric ER	81; 4-15 yr	The combination of all 3 agents in pediatric ER improved analgesia compared with only N2O and hematoma block combination
Lee et al[48], 2012	Comparison of the sedaoanalgesia profile of N2O vs IV ketamine	Prospective, randomized study at ER of a single academic center in children undergoing primary repair of a laceration wound	32; 3-10 yr	N2O was found preferable to ketamine because it provides a faster recovery, is safe, and maintains a suitable safe plane of sedation
Srinivasan et al[49], 2013	Determine the effectiveness and safety of procedural sedation performed using ketamine (0.5-1 mg/kg) or N2O (50%-70%).	Retrospective review and analysis of a quality improvement database for procedural sedations performed at St Louis Children’s Hospital undergoing sedation by pediatric hospitalists	8870; 7 mo to 4 yr	Combination of ketamine and N2O provides lowest rates of complications. Respiratory and cardiovascular events occurred more frequently with ketamine, whereas NV, sedation level not achieved, and procedure not completed were more frequent with N2O

N₂O: Nitrous oxide; ER: Emergency room; IV: Intravenous; NV: Nausea vomiting.