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VOLUME 16 , ISSUE 2 ( March-April, 2023 ) > List of Articles

ORIGINAL RESEARCH

Objectivation of the Equimolar Mixture of Oxygen and Nitrous Oxide Anxiolytic Effect in Pediatric Dentistry: A Pilot Study

Roselyne Clouet, Sylvie Dajean-Trutaud, Marie Grall-Bronnec, Estelle Bray, Caroline Victorri-Vigneau, Tony Prud homme

Keywords : Dental anxiety, Equimolar mixture of oxygen and nitrous oxide, Heart rate

Citation Information : Clouet R, Dajean-Trutaud S, Grall-Bronnec M, Bray E, Victorri-Vigneau C, Prud homme T. Objectivation of the Equimolar Mixture of Oxygen and Nitrous Oxide Anxiolytic Effect in Pediatric Dentistry: A Pilot Study. Int J Clin Pediatr Dent 2023; 16 (2):270-275.

DOI: 10.5005/jp-journals-10005-2540

License: CC BY-NC 4.0

Published Online: 12-05-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Aim: EMONO is an equimolar mixture of oxygen and nitrous oxide. Studies investigating its anxiolytic effect mostly used behavioral scales for assessing anxiolysis in children during dental care. Observing this effect objectively in a pediatric population could be very interesting. Materials and methods: We conducted a prospective uncontrolled monocentric pilot study to assess the equimolar mixture of oxygen and nitrous oxide (EMONO) anxiolytic effect in children during dental care by monitoring heart rate (HR) variation. Results: A statistically significant difference could be highlighted between the HR before the dental care and after 5 minutes of EMONO inhalation, illustrating the anxiolytic effect of EMONO in an objective way. HR variation also suggests that the effect of EMONO seems to prevent a return to the initial level of stress, even during anesthesia. Conclusion: All of the data in the literature confirm the essential role of nitrous oxide in pediatric dental care. Demonstrating the effectiveness of EMONO by objective criteria is necessary. Trial registration: Clinical Trials Unique Protocol ID: RC17_0275.

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  1. base-donnees-publique.medicaments.gouv.fr
  2. Paterson SA, Tahmassebi JF. Pediatric dentistry in the new millennium: 3. Use of inhalation sedation in paediatric dentistry. Dent Update 2003;30(7):350–356. DOI: 10.12968/denu.2003.30.7.350
  3. Dock M, Creedon RL. Pharmacologic management of patient behavior. In: McDonald and Avery's Dentistry for the Child and Adolescent. 9th ed. Maryland Heights, Mo: Mosby; 2011:261–264.
  4. American academy of pediatric dentistry. Guideline on use of nitrous oxide for pediatric dental patients. Pediatr Dent 2013;35(5):E174–E178.
  5. Rosen MA. Nitrous oxide for relief of labor pain: a systematic review. Am J Obstet Gynecol 2002;186(5):S110–S126. DOI: 10.1067/mob.2002.121259
  6. Maze M, Fujinaga M. Recent advances in understanding the actions and toxicity of nitrous oxide. Anaesthesia 2000;55(4):311–314. DOI: 10.1046/j.1365-2044.2000.01463.x
  7. Maze M, Fujinaga M. Pharmacology of nitrous oxide. Best Pract Clin Anesthesiol 2001;15(3):339–348. DOI: 10.1053/bean.2001.0166
  8. Emmanouil DE, Quock RM. Advances in understanding the actions of nitrous oxide. Anesth Prog 2007;54(1):9–18. DOI: 10.2344/00033006(2007)54[9:AIUTAO]2.0.CO;2
  9. Sanders RD, Weimann J, Maze M, et al. Biologic effects of nitrous oxide: a mechanistic and toxicologic review. Anesthesiology 2008;109(4):707–722. DOI: 10.1097/ALN.0b013e3181870a17
  10. Hopkins PM. Nitrous oxide: a unique drug of continuing importance for anaesthesia. Best Pract Res Clin Anaesthesiol 2005;19(3):381–389. DOI: 10.1016/j.bpa.2005.03.002
  11. Wilson KE. Overview of paediatric dental sedation: 2. Nitrous oxide/oxygen inhalation sedation. Dent Update 2013;40(10):822–824, 826–829. DOI: 10.12968/denu.2013.40.10.822
  12. Brunick A, Clark MS. Nitrous oxide and oxygen sedation: an update. Dent Assist 2013;82(4):12.
  13. Craig DC, Wildsmith JA. Conscious sedation for dentistry: an update. Br Dent J 2007;203(11):629–631. DOI: 10.1038/bdj.2007.1105
  14. Holroyd I, Roberts GJ. Inhalation sedation with nitrous oxide: a review. Dent Update 2000;27(3):141–142, 144, 146. DOI: 10.12968/denu.2000.27.3.141
  15. Foley J. A prospective study of the use of nitrous oxide inhalation sedation for dental treatment in anxious children. Eur J Paediatr Dent 2005;6(3):121–128.
  16. Holroyd I. Conscious sedation in pediatric dentistry. A short review of the current UK guidelines and the technique of inhalational sedation with nitrous oxide. Paediatr Anaesth 2008;18(1):13–17. DOI: 10.1111/j.1460-9592.2007.02387.x
  17. Lyratzopoulos G, Blain KM. Inhalation sedation with nitrous oxide as an alternative to dental general anaesthesia for children. J Public Health Med 2003;25(4):303–312. DOI: 10.1093/pubmed/fdg068
  18. Nathan JE. Management of the difficult child: a survey of pediatric dentists' use of restraints, sedation and general anesthesia. ASDC J Dent Child 1989;56(4):293–301.
  19. Collado V, Nicolas E, Faulks D, et al. A review of the safety of 50% nitrous oxide/oxygen in conscious sedation. Expert Opin Drug Saf 2007;6(5):559–571. DOI: 10.1517/14740338.6.5.559
  20. Onody P, Gil P, Hennequin M, et al. Safety of inhalation of a 50% nitrous oxide/oxygen premix: a prospective survey of 35 828 administrations. Drug Saf 2006;29(7):633–640. DOI: 10.2165/00002018-200629070-00008
  21. Hennequin M, Collado V, Faulks D, et al. A clinical trial of efficacy and safety of inhalation sedation with a 50% nitrous oxide/oxygen premix (Kalinox™) in general practice. Clin Oral Investig 2012;16(2):633–642. DOI: 10.1007/s00784-011-0550-y
  22. Collado V, Nicolas E, Faulks D, et al. Evaluation of safe and effective administration of nitrous oxide after a postgraduate training course. BMC Clin Pharmacol 2008;8:3. DOI: 10.1186/1472-6904-8-3
  23. Bonafé-Monzó N, Rojo-Moreno J, Catalá-Pizarro M, et al. Analgesic and physiological effects in conscious sedation with different nitrous oxide concentrations. J Clin Exp Dent 2015;7(1):e63–e68. DOI: 10.4317/jced.52034
  24. Annequin D, Carbajal R, Chauvin P, et al. Fixed 50% nitrous oxide oxygen mixture for painful procedures: a French survey. Pediatrics 2000;105(4):E47. DOI: 10.1542/peds.105.4.e47
  25. Doersch KM, Thai KH, Machen GL, et al. A comparison of clinical outcomes of operating room versus office-based ureteral stenting with the novel use of nitrous oxide sedation. Urology 2019;132:37–42. DOI: 10.1016/j.urology.2019.07.010
  26. Collado V, Hennequin M, Faulks D, et al. Modification of behavior with 50% nitrous oxide/oxygen conscious sedation over repeated visits for dental treatment a 3-year prospective study. J Clin Psychopharmacol 2006;26(5):474–481. DOI: 10.1097/01.jcp.0000236660.01039.eb
  27. Prud'homme T, Dajean-Trutaud S, Rousselet M, et al. The MEOPAeDent trial protocol-an observational study of the equimolar mixture of oxygen and nitrous oxide (EMONO) effects in paediatric dentistry. BMC Oral Health 2019;19(1):42. DOI: 10.1186/s12903-019-0732-6
  28. Prud'homme T, Allio A, Dajean-Trutaud S, et al. Assessment of equimolar mixture of oxygen and nitrous oxide: effects in pediatric dentistry. Int J Clin Pediatr Dent 2019;12(5):429–436. DOI: 10.5005/jp-journals-10005-1658
  29. Michels N, Sioen I, Clays E, et al. Children's heart rate variability as stress indicator: association with reported stress and cortisol. Biol Psychol 2013;94(2):433–440. DOI: 10.1016/j.biopsycho.2013.08.005
  30. Ekbom K, Jakobsson J, Marcus C, et al. Nitrous oxide inhalation is a safe and effective way to facilitate procedures in paediatric outpatient departments. Arch Dis Child 2005;90(10):1073–1076. DOI: 10.1136/adc.2004.060319
  31. Dworkin SF, Chen AC, Schubert MM, et al. Analgesic effects of nitrous oxide with controlled painful stimuli. J Am Dent Assoc 1983;107(4):581–585. DOI: 10.14219/jada.archive.1983.0303
  32. Thomas A, Miller JL, Couloures K, et al. Non-intravenous sedatives and analgesics for procedural sedation for imaging procedures in pediatric patients. J Pediatr Pharmacol Ther 2015;20(6):418–430. DOI: 10.5863/1551-6776-20.6.418
  33. Pasarón R, Burnweit C, Zerpa J, et al. Nitrous oxide procedural sedation in non-fasting pediatric patients undergoing minor surgery: a 12-year experience with 1,058 patients. Pediatr Surg Int 2015;31(2):173–180. DOI: 10.1007/s00383-014-3608-5
  34. Hee HI, Goy RW, Ng AS, et al. Effective reduction of anxiety and pain during venous cannulation in children: a comparison of analgesic efficacy conferred by nitrous oxide, EMLA and combination. Paediatr Anaesth 2003;13(3):210–216. DOI: 10.1046/j.1460-9592.2003.01051.x
  35. Paut O, Calméjane C, Delorme J, et al. EMLA versus nitrous oxide for venous cannulation in children. Anesth Analg 2001;93(3):590–593. DOI: 10.1097/00000539-200109000-00012
  36. Kim HG, Cheon EJ, Bai DS, et al. Stress and heart rate variability: a meta-analysis and review of the literature. Psychiatry Investig 2018;15(3):235–245. DOI: 10.30773/pi.2017.08.17
  37. Kemp AH, Quintana DS. The relationship between mental and physical health: insights from the study of heart rate variability. Int J Psychophysiol 2013;89(3):288–296. DOI: 10.1016/j.ijpsycho.2013.06.018
  38. Pedersen RS, Bayat A, Steen NP, et al. Nitrous oxide provides safe and effective analgesia for minor paediatric procedures–a systematic review. Dan Med J 2013;60(6):A4627.
  39. Yon MJY, Chen KJ, Gao SS, et al. An introduction to assessing dental fear and anxiety in children. Healthcare 2020;8(2):86. DOI: 10.3390/healthcare8020086
  40. Salas Huamani JR, Barbosa TS, de Freitas CN, et al. Assessment of anxiety and stress markers in children submitted to educational strategies and ART-restoration: a randomized clinical trial. Arch Oral Biol 2019;97:191–197. DOI: 10.1016/j.archoralbio.2018.10.032
  41. Venham LL, Gaulin-Kremer E, Munster E, et al. Interval rating scales for children's dental anxiety and uncooperative behavior. Pediatr Dent 1980;2(3):195–202.
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