title: Nitrous oxide-oxygen inhalation for outpatient otologic examination and minor procedures performed on the uncooperative child.
abstract: OBJECTIVE
  Otomicroscopic examination with suctioning of ears or other procedures is frequently uncomfortable especially for children. Anxiety and pain with lack of cooperation may result in trauma to the ear, incompletion of the examination, delayed diagnosis and treatment and need for completion of the examination under general anesthesia. The purpose of this study was to evaluate the efficacy and safety of utilizing nitrous oxide-oxygen inhalation for sedation and analgesia in otologic examination and minor surgical procedures performed on the uncooperative child at the outpatient clinic.
  
  
  METHODS
  In a prospective pilot case series study conducted at the Pediatric Otolaryngology outpatient clinic of a tertiary medical center, nitrous oxide-oxygen inhalation was administered by the examining otolaryngologist and the assisting nurse. The study group included children over 2 years old, for which an accurate diagnosis of ear pathology could not be made or a minor surgical procedure could not be tolerated because of anxiety and lack of cooperation.
  
  
  RESULTS
  Completion of the indicated procedure was successful in 21 of 24 patients (88%). Full cooperation, where no restraint was necessary was achieved in 20 of 24 patients (83%). The mean rank pain scores, evaluated separately by the patient, parent and staff, were in the mild pain range using a 0-10 coding for Faces Pain Rating Scale. The mean procedure time was 8.9 min. An adverse reaction, vomiting, occurred in one patient. Twenty-one of 24 parents stated that they would repeat the procedure if necessary.
  
  
  CONCLUSIONS
  This pilot study shows the potential usefulness of nitrous oxide-oxygen inhalation administered by an otolaryngologist in the outpatient clinic. Alleviation of pain and anxiety and avoiding the need for physical restraint is an important goal that can be achieved with this form of sedation.
authors.affiliation: Pediatric Otolaryngology Unit, Dana Children's Hospital, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, 6 Weizmann St., Tel-Aviv 64239, Israel. nognet@sbcglobal.net
authors.forename: Gadi
authors.initials: G
authors.lastname: Fishman
authors.forename: Eyal
authors.initials: E
authors.lastname: Botzer
authors.forename: Nisim
authors.initials: N
authors.lastname: Marouani
authors.forename: Ari
authors.initials: A
authors.lastname: DeRowe
mesh_terms: D018685:Anesthetics, Inhalation / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003939:Diagnostic Techniques, Otological; D005260:Female; D006801:Humans; D008297:Male; D009609:Nitrous Oxide / Q000008:administration & dosage*; D013506:Otologic Surgical Procedures / Q000379:methods; D038781:Otoscopy / Q000379:methods; D010045:Outpatients; D010100:Oxygen / Q000008:administration & dosage*; D010146:Pain / Q000517:prevention & control; D017060:Patient Satisfaction; D010865:Pilot Projects; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D018685:Anesthetics, Inhalation; D009609:Nitrous Oxide; D010100:Oxygen