Physiological and psychomotor effectiveness of rapid and slow induction of nitrous oxide inhalation sedation in pediatric patients undergoing dental procedures:a randomized clinical study
10.17245/jdapm.2025.25.6.387
- Author:
Sneha Chandulal DORI
1
;
Anshula N DESHPANDE
;
Simron BAISHYA
;
Vidhi JAISWAL
;
Sakshi MISHRA
;
Medha WADHWA
Author Information
1. Department of Pediatric and Preventive Dentistry, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujrat, India
- Publication Type:Original Article
- From:Journal of Dental Anesthesia and Pain Medicine
2025;25(6):387-398
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background:Nitrous oxide–oxygen (N2O:O2 ) inhalation sedation is a safe and effective technique for managing dental anxiety and achieving light conscious sedation. It increases the pain threshold, reduces fatigue, and improves patient cooperation. Two primary induction techniques are used: slow and rapid induction, with the latter preferred for highly anxious or uncooperative patients who require immediate sedation during dental procedures. This study aimed to evaluate the efficacy of different concentrations of N2O:O2 inhalation sedation and to assess changes in physiological and psychomotor parameters, and post-sedation recovery, in pediatric patients.
Methods:A total of 78 children who met the inclusion criteria were randomly divided into three groups: Group A (conventional slow induction), Group B (rapid induction with 30:70 N2O:O2 ), and Group C (rapid induction with 50:50 N2O:O2 ). Demographic and medical data were recorded. Baseline vital signs and the Trieger Dot Test were performed before treatment. Induction was carried out according to group protocol. The Face, Legs, Activity, Cry, Consolability (FLACC) pain score and the Observer’s Assessment of Alertness/Sedation (OAA/S) scale were used to assess pain and sedation levels, respectively. Vital signs were monitored during and after treatment.Post-recovery, the Trieger Dot Test was repeated, and a 24-hour follow-up call was made to assess the child’s well-being.
Results:All groups maintained vital signs within normal limits. Differences in pain perception and psychomotor impairment were statistically non-significant. A statistically significant difference was observed in the sedation levels among the groups (P = 0.033). Light sedation was achieved in 69.23%, 57.69%, and 73.08% of participants in Groups A, B, and C, respectively, while moderate sedation was observed in 19.23% of participants in the 50:50 induction group. A 24-hour telephonic follow-up revealed that all children had resumed normal activities and daily routines.
Conclusion:The results provide clinicians with evidence-based guidance on N2O:O2 titration and induction techniques. The preadjusted mixture of 30% N 2 O and 70% O 2 offers a more efficient approach to achieving an adequate depth of sedation in a shorter period while increasing pain tolerance. Therefore, it can serve as an effective alternative to slow induction for administering N2O:O2 inhalation sedation in restless and anxious pediatric patients.
