The Science Journal of the American Association for Respiratory Care

1998 OPEN FORUM Abstracts

DELIVERY OF NITROUS OXIDE VIA THE SERVO 900C VENTILATOR FOR PAIN CONTROL DURING DRESSING CHANGES, AND WOUND DEBREIDMENT.

Chris Cella, RRT, Terry Jordan, RRT. Josh Benditt, MD, University of Washington Medical Center, Seattle WA.

Introduction- Nitrous oxide (N_{2}O) is provided for analgesia to suitable patients who require short painful procedures at frequent intervals. Currently our institution utilizes a program whereby the Acute Pain Service (APS) is consulted for use of N_{2}O. The APS physician evaluates the patient prior to use, and is present for the first administration of N_{2}O. Thereafter at the discretion of the physician, N_{2}O may be administered by an Respiratory Care Practitioner (RCP). Patients are carefully monitored by the RCP for level of consciousness. A pulse oximeter is used to monitor heart rate and spO2. Mixtures are limited to a maximum of .50 nitrous oxide.

We present a case study, whereby a 63 yo female with squamous cell carcinoma of the nasopharynx and tracheostomy tube, was having difficulties weaning from mechanical ventilation. The patient was undergoing painful dressing changes to her right calf TID. She was medicated with morphine sulfate which was administered intravenously prior to each dressing change. Her level of consciousness was significantly decreased following each procedure for 2-3 hours, hindering weaning efforts. At the request of APS, .50 N_{2}O/.50 O2 was delivered via a Bird N_{2}O/02 blender to the low flow inlet of a Servo 900C ventilator. FIO2 was analyzed on the inspiratory limb of the circuit, and exhaled gases were scavenged by a venturi vacuum device. The patient tolerated the dressing change well with N_{2}O alone for analgesia. 24 hours after the initiation of this therapy, the patient was weaned from mechanical ventilation, and placed on humidified oxygen. During the next 72 hours N_{2}O was delivered by resuscitator bag (exhaled gas was scavenged via a PEEP divertor attached to a vacuum venturi device) during dressing changes. After this time the patients condition improved, and she no longer required N_{2}O.

Discussion--N_{2}O can safely and effectively be delivered through the Servo 900C ventilator and used as an alternative to IV medications for analgesia during short painful procedures. Careful monitoring must be done to insure safety during this procedure. Considerations must be made about N_{2}O concentrations set relative to necessary FIO2's being delivered. Further study of use of this gas delivery system is necessary.

The 44th International Respiratory Congress Abstracts-On-DiskĀ®, November 7 - 10, 1998, Atlanta, Georgia.

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