Nitrous Oxide

[jshet]

Hi!
My post is for anyone who has had nitrous oxide during a dental procedure either adults or children with cf. My son had a small cavity that needed taken care of, and the dentist thought "giggle gas" would be best rather than giving him a shot.
The dentist is the head of the dental department at Children's Hospital Pgh., and treats lots of kids with special needs.
About 2 minutes in, my son stopped responding. His eyes were closed, and the dentist was shaking him and asking him if he was ok, (he was shaking his head yes that he was ok prior when the dentist asked), but now nothing. I jumped up, grabbed my sons hand, and nothing. He was lifeless. Kept calling his name and be wasnt responding. After what seemed like forever, but was probably a minute, he opened his eyes and seemed fine. He has no memory of this happening.
i said to the dentist after he was ok, that that scared the crap out of me, he looked right at me and said yeah, me too.
today we saw his peditrician and i told him about it. He said, after checking the internet that nitrous oxide is safe and used with all ages, but it has contraditions for people with respirtory disease, pulmonary disease, and cystic fibrosis. i wa stunned. The dentist is fully aware of all my sons diagnoses.
my question is if any of you or your children have had any similar experiences or told it could not be used on you based on your cystic fibrosis?
We will never use this again, thats for sure. I just worry what the heck was going on with him while this was happening. Doctor asked if they checked his pulse or breathing while this was happening, and no one did.
the only otherthing was that my son was super tired the rest of the day.
sorry for such a long post. Thank you in advance, jshet

 

[Ratatosk]

How absolutely frightening! DS has had two teeth pulled, two separate times in the dentist office and a topical anesthesia was used, followed by the shot. He has such a needle phobia, I was surprised he did so well; however, the dentist never let him see the needle. To this day I don't think he's aware they used a needle on him. The little weirdo actually thought it was fun.

 

[imported_Momto2]

I've had nitrous once a long time ago. Never again. I cant really explain what happened, but whatever did caused a panic reaction in me and I ripped off the mask and wouldnt put it back on. I have also reacted very badly to anesthetics before. Once, got put in a coma, another time I had complete auditory recall of the whole procedure. Creepy. (but no pain). I have heard that people with CF often metabolize anesthetics differently and that extra care should be used.

I did read somewhere that nitrous should not be used in CF patients because of the increased airway resistance can cause hypoxia.

 

[jaimers]

That is SO scary! I know I've been knocked out a few times for various things but not sure if it was ever with nitrous. I'll be making sure from now on that I don't get that. Man. Glad he's ok!

 

[jshet]

Thank you everyone. I hope many see this and learn that nitrous oxide isn't a good idea to use if you have cf. Scared me to death. wouldnt want anyone else to experience this.

 

[LittleLab4CF]

Wow! One should expect the dentist to at least double check her/his PDR before administering anesthesia for someone with a serious respiratory disease. Thanks for the warning, I was wondering what the interaction might be when I saw the post topic.

I half expected it would act like nitrous oxide boosting engine performance by acting like concentrated oxygen! Anesthesia is not appropriate when the "anesthesiologist " isn't qualified. Due to my opioid tolerance for many decades when I have a colonoscopy or any surgery/procedure requiring sedation, my pain management doctor/ Anesthesiologist is controlling my slumber.

Dentists that administer more than a local numbing need to be able to prove that they or some person is current and qualified to do conscious sedation. They also need to be currently certified and equipped to revive a patient from anesthesia related reactions and such.

To this day I can't get the mental picture of this dentist having abandoned a dying patient to stand out at the street to await an ambulance. It is a news event about 2009 in Denver Colorado. The dentist was so panicked he was waving down the busy traffic asking for qualified help. His patient died.

In a way, I'm not surprised. Every time I see my dentist I look at the dusty cover on the emergency oxygen bottle and thank my tooth fairy for not needing conscious sedation. Wisdom teeth extraction is usually where the heavy sedation is needed. When I had mine done long ago, they forgot to remove the tourniquet before injecting the anesthesia. By the time they realized the error I had one bulging vein filled with pure poison. They snapped the tourniquet and I got a head rush I still can re-live. The damage was to my bulging vein.

Over the next weeks and then months this deep vein highlighted by green then a yellow streak punctuated by vein segments that surfaced looking like a tiny busted up sewer pipe. The real damage was about five years of neuropathic pain. This can't compare to the terror that must have been central to your experience.

Glad it turned out,
LL

 

[cfgf28]

I work for a dentist, I'm amazed that yours didn't request some type of release from your medical dr to use nitrous. We require a release to do a cleaning without nitrous on patient s with heart issues, and kind of joint replacements, pregnant patients. I'm just amazed that a major respiratory disease isn't something they would want to double check with another provider on. We don't use nitrous in the office I work in because we don't have the clearances in place from the state, health dept etc. it is something that a dentist has to be certified in, our is just one particular office in our group is not. I'm so glad your son is okay! My fiance had wisdom teeth surgery done with just local anesthesia and it was terrible. He had them done at the same hospital that his cf clinic is in, but the dentist didn't read the doctors handwriting correctly to see that he could have been put under for it... so your son may need something different in the future, just not nitrous. My kids have never had it, but have done just fine with novacaine, it really just depends on how well the dentist is with children, and their injection technique. I hope he has a better experience next time.

 

[jshet]

Thank you LL and cfgf28. This is definetly not going to be a situation that is repeated. He will never have nitrus oxide again. I did not have to sign any type of release or anything. I think the thought was that with the possibility of my son getting super upset the nitrus was the best thing to help keep him relaxed. Luckily all of the specialists at our Children's Hospital are located in the same area. There are doctors all around if this would have progressed further, like feet away.

if there is a next time, his doctor will prescribe something for him to take prior to any procedure. Without something, we would have to hold him down, and that would be super traumatizing for him. He is 18, but developmentally he is much younger. I hope many see this, and do not allow it to be used on them ir their children if they have cf.

 

[imported_Momto2]

Regarding novacaine, I have noticed that I metabolize it (and other painkillers) extremely quickly and usually have to get "booster" shots during a dental procedure. That might be useful info to keep in mind if your son is not good at communicating his needs and you want to make doubly sure he feels no pain. I have heard this from other CFers as well. (painkillers wearing off very quickly, metabolizing caffeine quickly, etc)

 

[jshet]

Thank you imported-Momto 2. I know that he also has issues with pain meds wearing off quickly, or not working at all. Forget Morphine. It has no effect on him. I think another reason the dentist may have wanted to avoid the novocane is that my son has many drug allergies, including difficulty breathing with a couple. He broke his elbow a few years ago, and the hospital we were at gave him valuim to keep him calm while he was transported to another hospital instead caused a severe mental health reaction. It was horrible. They said they have never seen anyone react that way.
but thankyou for letting me know how novocane affects you, i will definetly keep that in mind if there is a next time. I brush his teeth for him, so this is the first cavity he has had in 5 years. Before that they did sadate him once to do some work.

 

[imported_Momto2]

Thats interesting about the valium...they gave it to me once prior to surgery and it hyped me up so much I was practically manic. Never again.

 

[jshet]

Thats what happened to him. He was also seeing things that were not there, and very violent, and trying to run away. It was horrible.
very intersting that you both had similar experiences. They had only given him 5 milagrams.
he had the same experience with Sinulair (for allergies).

 

[Ratatosk]

On a side note, since you mentioned brushing your son's teeth for him. After dealing with ds' teeth being stained from chewable vitamins and issues with tartar from not brushing all that great, we invested in an electric tooth brush. Got a highly rated one on sale at Costco and his teeth are much better. No issues with cavities yet, but he has had issues with baby teeth not coming out and permanent teeth not coming in, so he's had to have two baby teeth removed.

 

[jshet]

Thank you Ratatosk. We did try an electric toothbrush a few year, it was one that sings. I still had to brush them for him. He has severe sensory issues. We can only use baby toothpaste on him. The feelng of the tooth brush in his mouth, he hates, and will do anything to avoid it if he dould.
might be worth a second try even if i have to do it. I'm sure it will do a better job.

 

[DmT145]

After reading the comments, it doesn't appear that anyone on this thread understands how nitrous works and why it can be a problem for respiratory patients. I'd suggest a little more reading, which will cut down on speculation and panic. It will also make for better informed choices in the future.

 

[2roses]

What a terrifying incident. Thank you so much for posting. Even if we Google treatments, the medical professional, in this case the dentist, in my opinion is responsible. My daughter needs to get her wisdom teeth out and her CF doc wants it done in the hospital. I thought that was overkill, but not anymore.

 

[jshet]

DmT145, I admit i do not know really anything about how nitrous oxide works, and honestly did not claim to. I was simply sharing our experience with it, and the fact that it is not recommended for anyone with cystic fibrosis. That was my only intention. As can be seen by the posts on here, many did not know that there is a contridiction regarding its use in cf patients. All i was trying to do if i could was prevent this from happening to anyone else, and to help others make an informed decision. Thats it.

 

[jshet]

2roses, i wish your daughter a quick recovery from her wisdom teeth surgery. My son had his done in the hospital under anesthesia, and it worked out really well. Definetly a lot safer having it done there. Good luck.

 

[Ratatosk]

Thank you Ratatosk. We did try an electric toothbrush a few year, it was one that sings. I still had to brush them for him. He has severe sensory issues. We can only use baby toothpaste on him. The feelng of the tooth brush in his mouth, he hates, and will do anything to avoid it if he dould.
might be worth a second try even if i have to do it. I'm sure it will do a better job.

we too tried the singing, battery operated disposable models. We finally got a higher end one. His is the compact brush, we use the larger brush heads for ourselves. Much faster brushing action than the disposable ones and adjustable speeds and times

 

[DmT145]

DmT145, I admit i do not know really anything about how nitrous oxide works, and honestly did not claim to. I was simply sharing our experience with it, and the fact that it is not recommended for anyone with cystic fibrosis. That was my only intention. As can be seen by the posts on here, many did not know that there is a contridiction regarding its use in cf patients. All i was trying to do if i could was prevent this from happening to anyone else, and to help others make an informed decision. Thats it.

CF isn't an absolute contraindication. What's interesting is you had a bad experience, posted about it, and now have several people publicly affirming that they will be avoiding nitrous. Yet you readily acknowledge that you have little to no understanding about how nitrous works.

This is like someone acknowledging that they know almost nothing about computers, but they had a bad experience with Microsoft tech support: Therefore, you should avoid PC and get a Mac.

While this wouldn't normally be a problem, we are talking about healthcare, specifically your child's healthcare. It worries me that a statement, completely unsupported by evidence and uttered by someone who doesn't understand the treatment, could be readily applied to choices by parents who are content to take medical advice (or a broadly painted warning) from an internet forum. Indeed, some people seem to be willing to toss out nitrous in favor of the more dangerous general anesthesia.

What would have been 100 times more beneficial (for you and anyone who is directly or indirectly participating in the conversation) would have been to create a post highlighting your experience and the fear you felt and then an explanation of what nitrous is, how it works, and why it can be a problem with people who have respiratory disease (especially with dental devices that attach to the patient Most nitrous administration sets rely on self-administration as a passive safety mechanism. If you get too much, you pass out, drop the mask, and start breathing room air again. This doesn't occur with most dental administration sets and therefore a practitioner should really know nitrous, and how it works, before using it in practice). By doing this you would have, at the very least, educated yourself and put the fear of something you don't currently understand to rest and at best educated a few other people who might not understand nitrous either. It's a win-win and doesn't lead to any mis-information getting out.