View Full Version : Nitrus Oxcide and Sedation


banannie0828
01-31-12, 10:41 PM
I need help, I don't know anyone to ask for help. My son has a molar that the dentist needs to pull but he won't let anyone near it. He freaks out. bad. Our last resorts are Nitrus Oxide and then sedation. he has severe adhd and is taking ritalin and I need to know if there is any side effects of this. Some one please help me.

cameron90
02-01-12, 01:01 AM
From Dental Implications of the ADHD Patient (http://www.dentalcare.com/media/en-US/education/ce359/ce359.pdf) regarding local anesthesia:

Local anesthesia should be used with caution with the ADHD patient. The dental practitioner should seek to achieve profound anesthesia so that endogenous epinephrine is not released which could react with medications (especially methylphenidate). In addition, an aspirating syringe must be used to avoid intravascular injections and the possibility of a summation of drug effects from the vasoconstrictor which could increase BP and heart rate.

Stimulants may also make it more difficult for someone to be sedated, requiring more of the sedative drug, but I'm not completely sure. I can't say much more about the effects of nitrous oxide and deeper sedation or anaesthesia than to inform the dentist of ALL medications that your child is currently on. I'm not sure if he should skip the dose or not, definitely ask the doctor about that. It's generally advised that you don't even eat or drink for a certain time before general anaesthesia. This is information that the dentist should be providing, because even nitrous oxide as a weak general anaesthesia carries risks for anybody, regardless of health, age or medication. I don't mean to worry you but I would assume that the dentist would be knowledgable about such things. It should be OK as long as the dentist and, if there's an anaesthetist present, both know of the ADHD and exactly what kind of medication is being taken, as early as possible prior to the dental work.

Hmm, apparently there has been relatively little research done on this topic:

General anesthesia in a juvenile with attention-deficit hyperactivity disorder accompanied by long-term use of methylphenidate (Concerta) (http://www.ncbi.nlm.nih.gov/pubmed/20015823)

Methylphenidate, a central stimulant, is used in the treatment of individuals who have attention-deficit hyperactivity disorder (ADHD). ADHD is a notorious worldwide disorder with a prevalence rate of 8-12% in schoolchildren, which is characterized by hyperactivity, impulsivity, and inattention. Currently, there have been few reports in the anesthetic literature examining ADHD patients who have had long-term use of methylphenidate, especially the extended-release formulation. Here, we report a case of a 14-year-old boy with ADHD treated chronically with the long-acting form of methylphenidate (Concerta), and who was scheduled to receive orthopedic surgery under general anesthesia. No significant problems or fluctuations in hemodynamics were encountered during anesthesia induction, maintenance, and emergence. The patient made an uncomplicated recovery and was discharged 3 days later without incident.

http://bja.oxfordjournals.org/content/100/3/421.2.full

Is Akathisia a Frequent Side Effect of Neuroleptics in Patients with Attention Deficit/Hyperactivity Disorder? (http://www.anesthesia-analgesia.org/content/103/2/507.2.full)

TygerSan
02-08-12, 10:23 AM
I dunno if Nitrous interacts with ritalin in such a way to make it less effective (it might), but that's definitely worth a shot (hopefully not too traumatic).

I had a tooth pulled with it once, and while it didn't do a heck of a lot to dull the pain, I really didn't care about sensations anymore. . . It made me a little loopy, very relaxed, and was kind of pleasant.

It's kind of mild though, so if your son is very hyperactive, I'm not sure how much it would settle him down. It also wears off very quickly, which is probably a good thing. I was able to drive home around 20 minutes after the procedure.

Laserbeak
08-03-13, 11:09 PM
I had a dentist who instead of nitrous prescribed me both Valium and Percodan (NOT Percocet that has Tylenol in it) the day before the tooth pulling so I could take it before the operation. It worked beautifully. Nitrous is very hallucinogenic, it has been called "hippy crack" but under controlled circumstances is generally safe.

Lunacie
08-03-13, 11:15 PM
I had a dentist who instead of nitrous prescribed me both Valium and Percodan (NOT Percocet that has Tylenol in it) the day before the tooth pulling so I could take it before the operation. It worked beautifully. Nitrous is very hallucinogenic, it has been called "hippy crack" but under controlled circumstances is generally safe.

I also had a dentist who offered Valium before dental work but I'm usually
good with just nitrous. I have severe dental phobia, related to some scary
sessions when I was in primary school, and my sensitivity to the numbing
stuff they inject in your gums. Nitrous seems to negate that reaction for me.

sarahsweets
08-04-13, 04:40 AM
i get novocain and the gas and the gas keeps me from getting out of the chair.

425runner
08-05-13, 09:09 AM
I get very hyper and anxious at the dentist too. I'm prescribed 0.5mg Klonopin so usually take that so I can sit in that chair and let him do his job. It's very hard...just to get myself there...but my dentist is nice and always tries to chat with me before he begins to work. I sort of makes me feel better that he's a trusted friend who only has good intentions.

Never had nitrous so can't comment on that, I dislike being sedated or anethesized. I like to be in control and not out of it. He needs to pull my 2 wisdom teeth so will let him inject Novocaine then.

Amtram
08-05-13, 09:10 AM
The doctor to contact is the one prescribing the Ritalin.

The good thing about Ritalin is that it's short-acting. You can simply not give it to your son the day you go to the dentist and the chances of an interaction with whatever miniscule amount might possibly be left in his system are pretty much nonexistent.

The epinephrine that cameron90 mentioned can be a concern. It's usually put into injectable medications to speed up the effect. Just tell the dentist in advance to use the versions that don't contain epinephrine, and it's not a problem - I've been getting those for years.

Laserbeak
08-18-13, 04:31 PM
I also had a dentist who offered Valium before dental work but I'm usually
good with just nitrous. I have severe dental phobia, related to some scary
sessions when I was in primary school, and my sensitivity to the numbing
stuff they inject in your gums. Nitrous seems to negate that reaction for me.

Yeah, but apparently this guy didn't 'have nitrous in the office. It probably worked out for the best though since they usually charge you $150 or so for the nitrous while I got these prescriptions filled for like $30.

Lunacie
08-18-13, 05:00 PM
I don't think I've ever been charged that much for nitrous.