Nurse administered relative analgesia using high concentration nitrous oxide to facilitate minor procedures in children in an emergency department

Aims: To describe the experience of using high concentration nitrous oxide (N2O) relative analgesia administered by nursing staff in children undergoing minor procedures in the emergency department (ED) and to demonstrate its safety. Method: Data were collected over a 12 month period for all procedures in the ED performed under nurse administered N2O sedation. All children greater than 12 months of age requiring a minor procedure who had no contraindication to the use of N2O were considered for sedation by this method. The primary outcome measure was the incidence of a major complication namely respiratory distress or hypoxia during the procedure. Secondary outcome measures were minor complications and the maximum concentration of N2O used. Results: Data were collected for a total of 224 episodes of nurse administered N2O sedation over a 12 month period. In 73.2% of children no complications were recorded. One major complication was recorded (respiratory distress) and the most common minor complication was mask intolerance in 17%. The mean maximum concentration of N2O used was 60.2%. Conclusions: N2O is a safe analgesic in children over the age of 1 year undergoing painful or stressful procedures in the ED. It may safely be administered in concentrations of up to 70% by nursing staff after appropriate training.