Pediatric Sedation and Analgesia Outside the Operating Room: Combining Intranasal Fentanyl and Inhaled Nitrous Oxide

Abstract

OBJECTIVE Combining intranasal fentanyl (IN FENT) with inhaled nitrous oxide (N2O) seems to have good properties for pediatric procedural sedation and analgesia (PSA). This study aims to assess the side effect rate of the combined use of IN FENT and N2O. METHODS We performed a retrospective, single-center study. Patients treated in either the pediatric emergency department (PED) or the pediatric surgery outpatient clinic (PSOC) were included, if they received PSA with IN FENT and nitrous oxide with 50% oxygen (N2O 50%). RESULTS Three hundred seventy-five patients were included over a period of 4 years. Median age was 9.4 years (range, 3.1 to 15.9) and 39% of patients were female. Overall side effect rate was 30% (114 patients). Most frequent was dizziness (n = 63, 17%; 95% CI, 13–21), followed by nausea (n = 23, 6%; 95% CI, 4–9) and emesis (n = 14, 4%; 95% CI, 2–6), with 35 patients having either nausea and/or emesis (9%; 95% CI, 7–13). No serious side effects were recorded (0%; 95% CI, 0–0.1). Of 298 patients with information regarding satisfaction, 280 patients would like the same sedation for a similar procedure in the future (94%; 95% CI, 90–96). We found no relation between previously described risk factors and emesis and/or nausea. CONCLUSIONS N2O 50% combined with IN FENT can be recommended as an effective and safe treatment in the PED and the PSOC. While the side effect rate, primarily dizziness, nausea and emesis was substantial, antiemetic prophylaxis is not indicated owing to the overall low incidence of nausea and emesis.