Conscious sedation with nitrous oxide in a tracheostomized patient: Case report

Authors

Keywords:

Tracheostomy; Nitrous Oxide; Dentistry; Ambulatory Care.

Abstract

Conscious sedation with nitrous oxide/oxygen (N₂O/O₂) is widely used in dentistry due to its safety, rapid titration, and minimal respiratory impact. However, there is a significant gap in the literature regarding its use in tracheostomized patients. This article presents a clinical case of conscious sedation with N₂O/O₂ in an adult tracheostomized patient, highlighting technique adaptation, monitoring, and clinical outcomes. This is a descriptive, observational study based on the treatment of a single patient, conducted with informed consent. The literature review revealed a lack of publications directly addressing the association between tracheostomy and nitrous oxide sedation in Dentistry, reinforcing the relevance of this report. Findings indicate that, despite initial limitations with the ventilatory mask due to gas leakage, administering the gas through a catheter inserted directly into the tracheostomy stoma proved effective and safe, providing adequate sedation and clinical stability throughout the procedure. It is concluded that nitrous oxide may be a viable option for tracheostomized patients, provided that technical adaptations, rigorous monitoring, and a trained professional are involved. Further studies are needed to establish specific protocols for this population.

References

Girard, T. D.; Kress, J. P.; Fuchs, B. D.; Thomason, J. W.; Schweickert, W. D.; Pun, B. T.; Taichman, D. B.; Dunn, J. G.; Pohlman, A. S.; Kinniry, P. A.; Jackson, J. C.; Canonico, A. E.; Light, R. W.; Shintani, A. K.; Thompson, J. L.; Gordon, S. M.; Hall, J. B.; Dittus, R. S.; Bernard, G. R. & Ely, E. W. (2008). Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet. 371(9607):126-34. doi: 10.1016/S0140-6736(08)60105-1.

Gorayb, S. B. S.; Braz, J. R. C.; Martins, R. H. G.; Módolo, N. S. P. & Nakamura, G. (2004). Umidificação e aquecimento de gases inalados durante ventilação artificial com baixo fluxo e fluxo mínimo de gases frescos. Rev Bras Anestesiol. 54(1):20-36. doi: 10.1590/s0034-70942004000100004.

Jackson, D. L.; Proudfoot, C. W.; Cann, K. F. & Walsh, T. (2010). The incidence of sub-optimal sedation in the ICU: A systematic review. Crit Care. 14:R240.

Kress, J.P.; Pohlman, A.S.; O’Connor, M.F. & Hall, J.B. (2000). Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med. 342(20):1471-7.

Long, L.; Ren, S.; Gong Y.; Zhao, H.; He, C.; Shen, L.; Zhao, H. & Ma, P. (2020). Different depths of sedation versus risk of delirium in adult mechanically ventilated patients: A systematic review and meta-analysis. PLoS ONE. 15(7):e0236014. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0236014

Mashima, A.; Furutani, K. & Baba, H. (2024). Anesthetic management using desflurane and nitrous oxide in a child with non-ketotic hyperglycinemia: a case report. JA Clin Rep. 10(1):79. doi: 10.1186/s40981-024-00762-9.

Mehta, S.; Burry, L.; Cook, D.; Fergusson, D.; Steinberg, M.; Granton, J.; Herridge, M.; Ferguson, N.; Devlin, J.; Tanios, M.; Dodek, P.; Fowler, R.; Burns, K.; Jacka, M.; Olafson, K.; Skrobik, Y.; Hébert, P.; Sabri, E. & Meade, M. (2012). Daily sedation interruption in mechanically ventilated critically ill patients cared for with a sedation protocol: a randomized controlled trial. JAMA. 308(19):1985-92. doi: 10.1001/jama.2012.13872.

Minhas, M. A.; Velasquez, A. G.; Kaul, A.; Salinas, P. D. & Celi, L. A. (2015). Effect of Protocolized Sedation on Clinical Outcomes in Mechanically Ventilated Intensive Care Unit Patients: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Mayo Clin Proc. 90(5):613-23. doi: 10.1016/j.mayocp.2015.02.016.

Nedergaard, H. K.; Jensen, H. I.; Stylsvig, M.; Lauridsen, J. T. & Toft, P. (2016). Non-sedation versus sedation with a daily wake-up trial in critically ill patients receiving mechanical ventilation – effects on long-term cognitive function: Study protocol fot a randomized controlled trial, a substudy of the NONSEDA trial. Trials. 17:269. doi: 10.1186/s13063-016-1390-5

Nedergaard, H. K.; Jensen, H. I.; Stylsvig, M.; Olsen H. T.; Korkmaz, S.; Strøm, T. & Toft P. (2020). Effect of Nonsedation on Cognitive Function in Survivors of Critical Illness. Crit Care Med. 48(12):1790-8. doi: 10.1097/CCM.0000000000004573.

Olsen, H. T.; Nedergaard, H. K.; Strøm, T.; Oxlund, J.; Wian, K. A.; Ytrebø, L. M.; Kroken, B. A.; Chew, M.; Korkmaz, S.; Lauridsen, J. T. & Toft, P. (2020). Nonsedation or Light Sedation in Critically Ill, Mechanically Ventilated Patients. N Engl J Med. 382(12):1103-11. doi: 10.1056/NEJMoa1906759.

Pereira, A. S. et al. (2018). Metodologia da pesquisa científica. [free ebook]. Santa Maria. Editora da UFSM.

Rother, E. T. (2007). Revisão sistemática x revisão narrativa. Acta Paulista de Enfermagem. 20(2), 5-6.

Shehabi, Y., Chan, L., Kadiman, S., Alias, A., Ismail, W. N., Tan, M. A. T. I., Khoo, T. M., Ali, S. B., Saman, M. A., Shaltut, A., Tan, C. C., Yong, C. Y., & Bailey, M. J. (2013). Sedation depth and long-term mortality in mechanically ventilated critically ill adults: a prospective longitudinal multicentre cohort study. Intensive Care Medicine. 39(5):910-8. (2012 = 2013)

Shetty, R. M.; Bellini, A.; Wijayatilake, D. S.; Hamilton, M. A.; Jain, R.; Karanth, S. & Namachivayam, A. (2018). BIS monitoring versus clinical assessment for sedation in mechanically ventilated adults in the intensive care unit and its impact on clinical outcomes and resource utilization. Cochrane Database Syst Rev. 2(2):CD011240. doi: 10.1002/14651858.

Soares, D. A. S.; Soares, A. S.; Wanzeler, A. M. V. & Barbosa, P. H. M .F. (2013). Sedação com óxido nitroso como adjuvante em procedimentos odontológicos. Belém, Pará: Centro Universitário do Pará (CESUPA).

Souza-Dantas, V .C.; Freitas, F. G. R. & Azevedo, L. C. P. (2022). Percepções e práticas sobre sedação superficial em pacientes sob ventilação mecânica: Um inquérito nacional. Rev Bras Ter Intensiva. 34(4):426-32.

Standey, T. H. & Liu, W. S. (1975). Tracheostomy and endotracheal tube cuff volume and pressure changes during thoracic operations. Ann Thorac Surg. 20(2):144-51. doi: 10.1016/s0003-4975(10)63868-4.

Steel, T. L.; Lokhandwala, S.; Caldwell, E. S.; Johnson, N. J.; Miller, C. D.; Gong, M. N. & Hough, C. L. (2021). Variability in sedation assessment among intubated patients in the emergency department. Acad Emerg Med. 28(10):1173-6. doi: 10.1111/acem.14259.

Strøm, T.; Martinussen, T. & Toft, P. (2010). A protocol of no sedation for critically ill patients receiving mechanical ventilation: A randomized trial. Lancet. 375(9713):475-80.

Tanaka, L. M.; Azevedo, L. C.; Park, M.; Schettino, G.; Nassar, A. P.; Réa-Neto, A.; Tannous, L.; de Souza-Dantas, V. C.; Torelly, A.; Lisboa, T.; Piras, C.; Carvalho, F. B.; Maia, M. de O.; Giannini, F. P.; Machado, F. R.; Dal-Pizzol, F.; de Carvalho, A. G.; dos Santos, R. B.; Tierno, P. F.; Soares, M. & Salluh, J. I. (2014). Early sedation and clinical outcomes of mechanically ventilated patients: a prospective multicenter cohort study. Crit Care. 18(4):R156. doi: 10.1186/cc13995.

Toassi, R. F. C. & Petry, P. C. (2021). Metodologia científica aplicada à área de saúde. (2ed). Editora da UFRGS.

Treggiari, M. M.; Romand, J. A.; Yanez, N. D.; Deem, S. A.; Goldberg, J.; Hudson, L.; Heidegger, C. P. & Weiss, N .S. (2009). Randomized trial of light versus deep sedation on mental health after critical illness. Crit Care Med. 37(9):2527-34. doi: 10.1097/CCM.0b013e3181a5689f

Published

01/12/2025

How to Cite

Garcia, A. R. ., De Paula, C. A. A. P. F. ., Oliveira, S. C. de ., Oliveira, Y. G. de ., Cordeschi, T., Ferreira, B. C., & Vieira, D. M. (2025). Conscious sedation with nitrous oxide in a tracheostomized patient: Case report. E-Acadêmica, 6(3), e0963667. Retrieved from https://www.eacademica.org/eacademica/article/view/667

Issue

Section

Health and Biological Sciences