title: Practice Patterns and Adverse Events of Nitrous Oxide Sedation and Analgesia: A Report from the Pediatric Sedation Research Consortium.
abstract: OBJECTIVE
  To describe practice patterns and adverse events associated with nitrous oxide (N2O) administration as the primary sedative outside the operating room in varied settings by a diverse range of providers, and to identify patient and sedation characteristics associated with adverse events.
  
  
  METHODS
  Data prospectively collected by the Pediatric Sedation Research Consortium, which is comprised of 40 children's and general/community hospitals, was retrospectively analyzed for children who received N2O as the primary sedative. Descriptive measures of patient and sedation characteristics and adverse events were reported. A multivariable regression model was used to assess potential associations between patient and sedation characteristics and adverse events.
  
  
  RESULTS
  A total of 1634 N2O administrations were identified. The majority was performed in sedation units, and most by advanced practice nurses or physician assistants. The most common adjunct medication was midazolam. There was a low prevalence of adverse events (6.5%), with vomiting as the most common (2.4%) and only 3 (0.2%) serious adverse events reported. The odds of vomiting increased when concomitant opioids were administered (OR 2.89, 95% CI 1.14, 7.32) and when nil per os (NPO) clear fluids <2 hours (OR 4.16, 95% CI 1.61, 10.76). NPO full meal <6 hours did not change the odds of vomiting (OR 1.42, 95% CI 0.57, 3.57). There were no aspiration events.
  
  
  CONCLUSIONS
  There was a very low prevalence of serious adverse events during N2O administration in children outside of the operating room and by nonanesthesiologists. The odds of vomiting increased when concomitant opioids were administered and NPO clear fluids <2 hours.
authors.affiliation: Division of Pediatric Emergency Medicine, Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY. Electronic address: dst2141@columbia.edu.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Tsze
authors.affiliation: Pediatric Emergency Medicine Associates, Children's Healthcare of Atlanta at Scottish Rite, Atlanta, GA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Mallory
authors.affiliation: Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, Boston, MA.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Cravero
mesh_terms: D000293:Adolescent; D000698:Analgesia / Q000379:methods / Q000706:statistics & numerical data*; D000769:Anesthesia, Inhalation / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009609:Nitrous Oxide / Q000009:adverse effects*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012044:Regression Analysis; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D009609:Nitrous Oxide