Nasal dental click

Transcription

(music) >> HI, I AM DR. COLETTE SMILEY, AND THIS IS KYRA POSTMA, AND WE ARE IN GRCC'S DENTAL CLINIC TODAY. I AM GOING TO GO THROUGH NITROUS OXIDE INHALATION SEDATION WITH YOU. WITH THIS VIDEO, I AM GOING TO DEMONSTRATE THE PREPARE ADMINISTRATION OF NITROUS OXIDE ANALGESIA. WE WILL BEGIN WITH THE EQUIPMENT AND OPENING THE TANKS. NEXT STEP, WE WILL GO ON TO PREPARING OUR PATIENT, INCLUDING BLOOD PRESSURE AND PULSE. WE WILL DETERMINE THE PATIENT'S PROPER TIDAL VOLUME. AND THEN, BEGIN NITROUS OXIDE ADMINISTRATION. ONCE NITROUS OXIDE ANALGESIA HAS TAKEN EFFECT, WE WILL, OF COURSE, PERFORM THE DENTAL PROCEDURE, COMPLETE THE PROCEDURE WITH 100% OXYGEN, AND DISMISS THE PATIENT AFTER, AGAIN, TAKING THEIR BLOOD PRESSURE AND PULSE. PRIOR TO SEATING THE PATIENT, IN FACT, WE ARE GOING TO SPEND A LITTLE BIT OF TIME WITH THE NITROUS OXIDE EQUIPMENT. I AM GOING TO OPEN THE TANKS, START THE SCAVENGING SYSTEM, AND FILL THE RESERVOIR BAG. SO, THE VERY FIRST THING YOU DO, KYRA, IS TURN ON THE TANKS. >> OKAY. >> OKAY? THIS IS OUR WRENCH. AND GREEN TANKS ARE ALWAYS OXYGEN. BLUE TANKS ARE ALWAYS NITROUS OXIDE. AND YOU TURN THE VALVE ON TOP COUNTERCLOCKWISE TO OPEN THE TANKS. ALL RIGHT? ON TOP OF THIS-- THIS IS A PORTABLE NITROUS OXIDE SYSTEM. AND ON TOP, YOU WILL SEE TANK PRESSURE GAUGES-- TANK PRESSURE GAUGES-- WHICH WILL SHOW YOU, IN THE CASE OF OXYGEN, HOW MUCH OXYGEN IS AVAILABLE IN THE TANK. THE PRESSURE GAUGE ON AN OXYGEN TANK REPRESENTS VERY ACCURATELY HOW MUCH OXYGEN IS REMAINING IN THE TANK. THAT IS NOT THE CASE FOR NITROUS OXIDE. THE NITROUS OXIDE TANK WILL LOOK FULL. THE PRESSURE WILL SHOW "FULL" UNTIL IT IS ABOUT A QUARTER FULL, AND THEN IT WILL DROP. SO I HAVE CONFIRMED THAT WE HAVE OXYGEN AND NITROUS OXIDE IN OUR TANKS. THE NEXT STEP IS SETTING UP THE SCAVENGING SYSTEM. SCAVENGING SYSTEM WORKS WITH OUR NORMAL HIGH-VOLUME EVACUATION, SO OUR NORMAL SUCTION. ALL RIGHT? WE TURN THE SUCTION ON... (suction noise) AND THEN INSERT THIS END OF THE SCAVENGER INTO THE SUCTION, JUST AS IF YOU WERE INSERTING A SUCTION TIP-- JUST AS IF YOU WERE INSERTING A SUCTION TIP. THERE IS AN ON/OFF VALVE, WHICH OF COURSE WE WANT "ON." AND TO DETERMINE THAT WE HAVE ADEQUATE SUCTION, WE NEED TO MAKE SURE THAT THE BLACK BALL IS IN THE GREEN ZONE. YOU CAN NOW GO AHEAD AND SEAT YOUR PATIENT. WE ALWAYS REVIEW OUR PATIENT'S MEDICAL HISTORY AND TAKE THEIR BLOOD PRESSURE AND PULSE. I HAVE ALREADY DONE THAT WITH KYRA. AND SHE'S GOOD AND HEALTHY AND READY FOR OUR CARE TODAY. NOW, IT'S TIME TO EXPLAIN TO YOUR PATIENT WHAT IS GOING TO HAPPEN WITH THEIR NITROUS OXIDE SEDATION TREATMENT, AND ANSWER, OF COURSE, ANY QUESTIONS THEY MAY HAVE. SO, KYRA, TODAY WE ARE GOING TO USE NITROUS OXIDE SEDATION. OUR PATIENTS THAT FIND IT HELPS THEM TREAT-- GET THROUGH TREATMENT VERY RELAXED AND VERY COMFORTABLY. YOU SHOULD FEEL COMFORTABLE AT ALL TIMES. IF AT ANY POINT, YOU FEEL UNCOMFORTABLE, ANYTHING MAKES YOU UNCOMFORTABLE, PLEASE LET ME KNOW RIGHT AWAY. >> OKAY. >> DO YOU HAVE ANY QUESTIONS FOR ME? >> NO. >> WONDERFUL, WONDERFUL. ALL RIGHT, SO I AM GOING TO GO AHEAD AND SET THE CHAIR BACK A BIT. AFTER REVIEWING THE PATIENT'S MEDICAL HISTORY, TAKING THEIR BLOOD PRESSURE AND PULSE, AND EXPLAINING THE PROCEDURE TO THEM, WE CAN NOW BEGIN THE SEDATION PROCEDURE. FIRST, YOU WILL TURN ON THE FLOW METER. AND THEN, FILL THE RESERVOIR BAG ABOUT TWO-THIRDS FULL, USING THE OXYGEN FLUSH VALVE... LIKE SO. THE NEXT STEP IS TO INSERT THE LINER INSIDE THE NASAL HOOD. THERE ARE DISPOSABLE LINERS. THERE ARE AUTOCLAVABLE LINERS. WE HAVE AUTOCLAVABLE LINERS HERE. THERE ARE DISPOSABLE LINERS THAT FIT CHILDREN. THERE ARE DISPOSABLE LINERS THAT FIT ADULTS. YOU SHOULD HEAR IT SNAP IN. WE START THE OXYGEN FLOW TO THE NASAL HOOD PRIOR TO PLACING IT OVER THE PATIENT'S NOSE. SO, KYRA, I AM GOING TO HAVE YOU GO AHEAD AND REST YOUR HEAD BACK FOR ME. THANK YOU, THANK YOU. I AM GOING TO PLACE THIS OVER YOUR NOSE. YOU ARE THEN WELCOME TO ADJUST IT, TO TOUCH THIS, MAKE SURE THAT IT IS COMFORTABLE FOR YOU, OR AS COMFORTABLE AS IT CAN BE. SO GO RIGHT AHEAD, YUP, AND FEEL FREE IF IT IS PUSHING SOMEWHERE OR UNCOMFORTABLE SOMEWHERE-- DOES THAT FEEL OKAY TO YOU? GREAT. WE DEFINITELY ALLOW OUR PATIENTS TO ADJUST THAT NASAL HOOD TO THEIR COMFORT. YOU SHOULD FEEL COMFORTABLE. YOU SHOULD NOT FEEL ANY KIND OF AIR COMING OUT UNDERNEATH THE NASAL HOOD OR KIND OF BLOWING UP TOWARD YOUR EYES. ARE YOU FEELING THAT ANYWHERE? >> UP HERE. >> A LITTLE BIT THERE. OKAY. HOW IS THAT? GOOD, WONDERFUL. AT THIS POINT, WE ESTIMATE WHAT THE PATIENT'S TIDAL VOLUME IS. TIDAL VOLUME IS THE AMOUNT OF GAS THAT YOU WOULD INHALE IN LITERS-- IN LITERS. SO ALMOST YOUR LUNG CAPACITY FOR GAS. SO, KYRA, RIGHT NOW, ALL I HAVE ON RIGHT NOW IS OXYGEN. AND OF COURSE, WHEN YOU THINK SOMEONE IS WATCHING YOU BREATHE, YOU BREATHE DIFFERENTLY, RIGHT? SO YOU SHOULD JUST BREATHE THROUGH YOUR NOSE AS BEST YOU CAN, AND YOU SHOULD BE ABLE TO BREATHE COMFORTABLY. IN OTHER WORDS, YOU SHOULDN'T FEEL LIKE YOU ARE HAVING TO-- (inhaling) EITHER GASP FOR AIR, LIKE YOU ARE NOT GETTING ENOUGH AIR, OR YOU SHOULDN'T FEEL AS THOUGH YOU ARE GETTING SO MUCH AIR THAT IT IS ALMOST FILLING YOUR CHEST. OKAY? >> I KIND OF FEEL LIKE I AM NOT GETTING ENOUGH. >> OKAY. SO IF THE PATIENT FEELS THAT SHE IS NOT GETTING ENOUGH, WE GO AHEAD AND INCREASE THE LITERS OF OXYGEN. I STARTED FOR KYRA AT SIX LITERS, WHICH WAS MY GUESSTIMATE, MY EDUCATED GUESS. BUT NOW, WE ARE GOING TO BRING IT UP TO SEVEN LITERS. AND AGAIN, WE WAIT FOR SOME TIME JUST TO ALLOW THE PATIENT TO DEVELOP A COMFORTABLE INHALE AND EXHALE. YOU SHOULD BE ABLE TO SEE THE RESERVOIR BAG MOVE A LITTLE BIT. YOU SHOULD BE ABLE TO SEE THE RESERVOIR BAG EXPAND AND CONTRACT. IF YOU ARE SEEING MOVEMENT WITH THE RESERVOIR BAG EXPANDING AND CONTRACTING YOU ARE GETTING CLOSE TO BEING CORRECT AS FAR AS THE TIDAL VOLUME GOES. SO I AM LOOKING AT THE GREEN TUBE HERE. OF COURSE, THE GREEN GOES WITH THE GREEN OF THE OXYGEN TANKS. AND THERE IS A BLACK BALL THAT I HAVE ADJUSTED TO EQUAL SEVEN LITERS. SO OUR MARKINGS ARE ONE, TWO, THREE, FOUR, FIVE, SIX, EIGHT, TEN. SO I AM AT THE LINE BETWEEN SIX AND EIGHT. SO, KYRA, ARE YOU STILL FEELING LIKE YOU ARE NOT GETTING QUITE ENOUGH AIR OR ARE YOU-- >> YEAH... UM, YEAH. >> OKAY, LIKE YOU NEED A LITTLE MORE? >> YEAH. >> OKAY. SO GREAT, GREAT. THE RESERVE BAG, AS I SAID-- YOU SHOULD SEE MOVEMENT IN THE RESERVOIR BAG, INHALING AND EXHALING. SHOULD THE BAG LOOK LIKE IT'S FILLED TIGHT LIKE A BALLOON, THAT MEANS YOU ARE PUTTING TOO MUCH OXYGEN-- YOU ARE PUTTING TOO MUCH AIR INTO THE PATIENT, AND THE PATIENT IS JUST NOT ABLE TO BREATHE ALL OF THAT. SO WHAT THEY ARE NOT ABLE TO BREATHE STAYS IN THE RESERVOIR BAG, FILLS IT UP LIKE A BALLOON. WHAT YOU SHOULD ALSO NOT SEE IS A COLLAPSED BAG. IF THE RESERVOIR BAG IS COLLAPSED IT MEANS THE PATIENT ISN'T GETTING ENOUGH OXYGEN. IT MEANS THEY ARE SUCKING IN EVERYTHING THAT YOU'RE GIVING THEM THROUGH THE FLOW METER PLUS THE EXTRA IN THE RESERVOIR BAG. IF YOUR BAG COLLAPSES, THEN THAT IS WHEN YOU WANT TO INCREASE THE AMOUNT OF OXYGEN. THAT'S WHAT WE ARE DOING HERE. ALL WE ARE DOING HERE IS WORKING TOWARD DETERMINING THE PATIENT'S PROPER TIDAL VOLUME. SO HOW IS MY PATIENT DOING? >> GOOD. >> GOOD. YOU ARE FEELING COMFORTABLE BREATHING? >> YUP. >> LIKE YOU ARE NOT HAVING TO SUCK IN EXTRA AIR? >> NO. >> OKAY. SO WE HAVE DETERMINED THE PATIENT'S TIDAL VOLUME TO BE EIGHT-- EIGHT LITERS. EIGHT LITERS IS KYRA'S TIDAL VOLUME TODAY. THAT DOESN'T MEAN THAT EIGHT LITERS WOULD BE KYRA'S TIDAL VOLUME IF SHE COMES FOR A SUBSEQUENT APPOINTMENT. EACH AND EVERY APPOINTMENT THE TIDAL VOLUME NEEDS TO BE DETERMINED INDIVIDUALLY FOR THAT PERSON AND THAT PATIENT ON THAT DAY. SO, KYRA, I AM GOING TO GO AHEAD AND BEGIN ADMINISTERING THE NITROUS OXIDE. WE BEGIN ADMINISTERING NITROUS OXIDE BY ADDING ONE LITER OF NITROUS OXIDE. SO WE'RE GONNA LOOK FOR THAT BLACK BALL TO COME UP. AND I AM GOING TO BRING THE BLACK BALL IN THE OXYGEN DOWN TO SEVEN. SO WE HAVE THE BLACK BALL AT NITROUS AT ONE LITER. WE HAVE THE BLACK BALL AT OXYGEN AT SEVEN LITERS. THE REASON I HAVE DONE THAT IS TO MAINTAIN OUR PROPER TIDAL VOLUME. WE DETERMINED KYRA'S TIDAL VOLUME TO BE EIGHT LITERS. I HAVE ADDED ONE LITER OF NITROUS GAS. I HAVE DECREASED THE OXYGEN TO SEVEN LITERS. SEVEN LITERS PLUS ONE LITER EQUALS EIGHT LITERS. THAT IS KYRA'S TIDAL VOLUME. THE FIRST LITER OF NITROUS OXIDE WE ADMINISTER FOR A FULL MINUTE. SO WE ALLOW A FULL MINUTE OF NITROUS OXIDE BEFORE WE BEGIN ADDING OTHER DOSES OF NITROUS OXIDE. AFTER THE FIRST LITER, WE WILL ADD ONE-HALF LITER OF NITROUS OXIDE EVERY MINUTE. THIS METHOD OF DOSING IS CALLED "TITRATION." TITRATION ALLOWS YOU TO GIVE THE PATIENT THE AMOUNT OF DRUG THEY NEED BUT JUST THE AMOUNT OF DRUG THEY NEED, NOT OVER-SEDATING, NOT GIVING THEM MORE DRUG THAN THEY NEED. SO WE JUST ADD THE NITROUS OXIDE INCREMENTALLY. WE TRY TO ALSO-- AND KYRA IS DOING A GREAT JOB HERE. WE GENERALLY ASK THE PATIENTS NOT TO CHAT A WHOLE LOT, NOT TO TALK A WHOLE LOT. WHEN PATIENTS TALK, WHEN PATIENTS EXHALE, THAT PUTS EXCESS NITROUS OXIDE INTO THE ROOM, INTO THE ENVIRONMENT, AND IN ADDITION TO OUR SCAVENGING SYSTEM, WE WANT TO MINIMIZE THE AMOUNT OF NITROUS OXIDE IN THE AMBIENT AIR. SO I WILL BE ASKING KYRA SOME QUESTIONS AS WE CONTINUE THE SEDATION PROCESS, AND WE WILL GO FROM THERE. SO KYRA, WE HAVE WAITED A MINUTE. I AM GOING TO GO AHEAD AND INCREASE THE AMOUNT OF NITROUS OXIDE BY A HALF LITER. SO WE HAVE GONE UP TO 1.5 LITERS WITH NITROUS, AND WE ARE GOING TO GO DOWN TO 6.5 WITH OXYGEN. GREAT. THE SIGNS OF NITROUS OXIDE SEDATION THAT WE WILL BE LOOKING FOR-- WE WILL LOOK TO MAKE SURE THAT THE PATIENT IS RELAXED, THE PATIENT IS COMFORTABLE. SOME PATIENTS JUST APPEAR KIND OF CHILL. THEY ARE JUST NOT BOTHERED BY ANYTHING. SOME PATIENTS WILL DESCRIBE TINGLING IN THEIR ARMS OR LEGS. SOME PATIENTS WILL DESCRIBE TINGLING AROUND THEIR MOUTH OR EVEN AN OVERALL WARM FEELING. SO THOSE ARE SOME OF THE SIGNS AND SYMPTOMS-- NOT "SYMPTOMS," BUT SIGNS THAT YOU WILL SEE FOR PROPER NITROUS OXIDE SEDATION. THE EYES REALLY TELL THE STORY. THE EYES REALLY TELL THE STORY. EYE MOVEMENT WILL BE DECREASED, AND ALSO THE EYES WILL START TO APPEAR REAL GLASSY. SO WATCHING EYES IS KEY TO MAKING SURE THAT THE PATIENT IS SEDATED, AND PROPERLY SEDATED. WITH A TIDAL VOLUME OF EIGHT LITERS, WE MAY END UP ADDING A BIT MORE NITROUS OXIDE FOR YOU TO ACHIEVE OUR PROPER SEDATION. AGAIN, WE HAVE WAITED A FULL MINUTE. WE CAN GO AHEAD AND ADD OUR NEXT HALF LITER OF NITROUS OXIDE. WE ARE UP TO TWO LITERS NOW OF NITROUS OXIDE AND ADJUSTED OUR OXYGEN TO SIX LITERS. REMEMBER SIX PLUS TWO IS EIGHT. WE ARE MAINTAINING OUR EIGHT LITER TIDAL VOLUME. SIGNS THAT WE DON'T WANT TO SEE IN OUR PATIENT. THE PATIENT SHOULD NOT FEEL DIZZY. THE PATIENT SHOULD NOT FEEL LETHARGIC. THE PATIENT SHOULD NOT FEEL HEADACHY OR A LITTLE NAUSEOUS. THE PATIENT SHOULD NOT FEEL LIKE THEY ARE FLOATING OR FLYING, HAVING SORT OF AN OUT-OF-BODY EXPERIENCE. SHOULD THE PATIENT BE FEELING ANY OF THOSE THINGS, THEN THAT IS A SIGN THEY ARE BECOMING OVER-SEDATED, AND THE NITROUS OXIDE NEEDS TO BE ADJUSTED DOWNWARD. WHEN SEDATION IS BECOMING EVIDENT, IT MAKES SENSE TO WAIT A LITTLE BIT LONGER BETWEEN DOSES. SO IF YOU ARE BEGINNING TO OBSERVE SOME OF THOSE SIGNS THAT WE TALKED ABOUT, PARTICULARLY THE GLASSY EYES SIGN, IN YOUR PATIENT, THEN WE WAIT A LITTLE BIT LONGER THAN ONE MINUTE IN BETWEEN DOSES, IN BETWEEN ADDING A DOSE, TO ALLOW THE PEAK EFFECT OF ONE DOSE TO TAKE EFFECT BEFORE WE ADD MORE NITROUS OXIDE. SO THAT IS REALLY WHAT WE ARE DOING NOW. I AM BEGINNING TO SEE-- YOU MIGHT HAVE NOTED THIS. I AM BEGINNING TO SEE IN KYRA'S EYES SORT OF A GLASSIER APPEARANCE, A MOIST APPEARANCE. EYE MOVEMENT IS SLOWING DOWN. SO WE ARE JUST STARTING TO GET THE VERY BEGINNING SIGNS OF NITROUS OXIDE SEDATION. WELL, WE DEFINITELY SEE IT IN YOUR EYES. YOU ARE SMILING A LITTLE BIT EASIER. THESE ARE ALL SIGNS THAT THE SEDATION IS BEGINNING TO TAKE EFFECT, THE SEDATION IS BEGINNING TO TAKE EFFECT. >> I DO FEEL REALLY RELAXED. >> GREAT. THE PATIENT HAS TOLD US SHE FEELS REALLY RELAXED. IN FACT, THERE IS NO NEED TO ADD ANY MORE NITROUS OXIDE. WE HAVE ACHIEVED THE LEVEL OF SEDATION THAT WE WANT TO. IN PRACTICE, YOU CAN GO AHEAD AND BEGIN YOUR DENTAL TREATMENT. WHATEVER TREATMENT YOU ARE GOING TO PERFORM THAT DAY, GO AHEAD AND BEGIN YOUR DENTAL TREATMENT, OF COURSE ALWAYS KEEPING AN EYE ON YOUR PATIENT, MAKING SURE THAT THEY ARE STILL FEELING RELAXED, THEY ARE STILL FEELING COMFORTABLE. AS I SAID EARLIER, KYRA, IF, AT ANY TIME, YOU FEEL UNCOMFORTABLE AT ALL, PLEASE LET US KNOW. WHAT HAPPENS, AS THE PATIENT ACHIEVES SEDATION, THEY TEND TO BREATHE A LITTLE BIT SLOWER. WHEN THEY BREATHE A LITTLE BIT SLOWER, THEY ARE EXHALING THE NITROUS OXIDE A LITTLE BIT SLOWER AND IN FACT ALMOST INCREASE THEIR SEDATION RATE A LITTLE BIT. THAT'S WHY, THROUGHOUT THE PROCEDURE, WE WANT TO MAKE SURE THEY ARE STILL FEELING COMFORTABLE AND NOT MOVING INTO THOSE SIGNS AND SYMPTOMS OF OVER-SEDATION, OF NAUSEOUS TO THEIR STOMACH OR FEELING DIZZY OR HEADACHY OR LETHARGIC. AS YOU NEAR THE END OF YOUR DENTAL TREATMENT-- SO WE HAVE COMPLETED YOUR TREATMENT TODAY. YOU GO AHEAD AND TURN OFF THE NITROUS OXIDE, AND TURN UP THE OXYGEN TO THE ORIGINAL TIDAL VOLUME. SO, AGAIN, WE DETERMINED EARLY ON THAT KYRA'S TIDAL VOLUME WAS EIGHT LITERS. I HAVE TURNED OFF THE NITROUS OXIDE. THE PATIENT IS NOW ON THEIR TIDAL VOLUME, EIGHT LITERS, OF PURE OXYGEN. AND THE PATIENT SHOULD RECEIVE 100% OXYGEN FOR FIVE MINUTES. THIS CAN VERY EASILY BE DONE AT THE END OF THE APPOINTMENT. SO LET'S SAY YOU ARE PERFORMING A SCALING AND ROOT PLANING. YOU HAVE COMPLETED YOUR SCALING AND ROOT PLANING. PERHAPS YOU ARE GOING TO POLISH THAT QUADRANT TODAY. IT'S VERY LIKELY YOU DON'T NEED SEDATION FOR THE POLISHING. GO AHEAD AND TURN OFF YOUR NITROUS, TURN ON THE 100% OXYGEN, AND BEGIN YOUR FIVE MINUTES OF 100% OXYGEN AS YOU FINISH UP YOUR TREATMENT. WHILE THE PATIENT IS HAVING 100% OXYGEN, WE WILL GO AHEAD AND TAKE HER BLOOD PRESSURE AND WE WILL TAKE PULSE AGAIN. KYRA, I AM GOING TO PUSH UP YOUR SLEEVE A LITTLE BIT-- >> OKAY. >> OKAY? THANK YOU. AND YOU CAN GO AHEAD AND REST YOUR ARM. KYRA, YOUR BLOOD PRESSURE NOW IS 128 OVER 74. WHEN WE STARTED IT WAS 118 OVER 78. IT'S VERY NORMAL TO HAVE THE BLOOD PRESSURE VARY ABOUT TEN POINTS OR SO IN EITHER DIRECTION, EITHER INCREASE TEN POINTS OR DECREASE TEN POINTS. THAT DOESN'T CAUSE US ANY KIND OF ALARM. >> OKAY. >> ALL RIGHT. I AM GOING TO GO AHEAD AND TAKE YOUR PULSE THEN. GREAT. AND YOUR PULSE IS 64. AFTER THE PATIENT HAS HAD 100% OXYGEN FOR FIVE MINUTES, WE WANT TO MAKE SURE THAT THEY FEEL 100% NORMAL. IT HASN'T QUITE BEEN FIVE MINUTES FOR YOU YET, KYRA, SO WE ARE GOING TO CONTINUE THAT FOR A LITTLE BIT. AGAIN, IF THE PATIENT FEELS LETHARGIC, HEADACHY, NAUSEOUS, SICK TO THEIR STOMACH, DIZZY EVEN AFTER FIVE MINUTES OF OXYGEN, THEN KEEP THE OXYGEN ON THEM FOR SOME ADDITIONAL TIME. SO WE KEEP THE OXYGEN ON AS LONG AS WE NEED TO UNTIL THE PATIENT FEELS BACK TO NORMAL. ONCE THE PATIENT HAS TOLD YOU THEY FEEL 100% BACK TO NORMAL, YOU CAN REMOVE THE NASAL HOOD, SLOWLY SIT THE CHAIR UP, AND IN FACT DISMISS THE PATIENT TO HOME, WORK, OR SCHOOL, WHEREVER THEY ARE GOING TO GO. THERE ARE REALLY NO SPECIAL POSTOPERATIVE PRECAUTIONS WITH NITROUS OXIDE SEDATION. NITROUS OXIDE SEDATION HAS BEEN USED OVER 160 YEARS WITH A REMARKABLE SAFETY RECORD. THERE ARE NO KNOWN CASES OF ALLERGY TO NITROUS OXIDE SEDATION. SO ONCE THE PATIENT HAS BEEN DISMISSED, YOU WILL TURN OFF THE TANKS. YOU WILL COMPLETE THE PATIENT RECORD AND, OF COURSE, STERILIZE OR DISINFECT THE TANKS. SO, KYRA, YOU NOW HAVE BEEN ON 100% OXYGEN FOR ABOUT THREE MINUTES OR SO-- THREE, FOUR MINUTES. HOW ARE YOU FEELING NOW? >> I FEEL BACK TO NORMAL. >> YOU FEEL BACK TO NORMAL? >> MMM-HMM. >> GREAT. EVEN IF THE PATIENT HAS TOLD YOU THEY FEEL BACK TO NORMAL AT THREE OR FOUR MINUTES, WE WAIT THE FULL FIVE MINUTES WITH 100% OXYGEN. HOW DID YOU FIND THE OVERALL EXPERIENCE? THIS HAS BEEN THE FIRST TIME YOU HAD NITROUS OXIDE SEDATION. DID IT-- HOW DID YOU FEEL, HOW DID YOU FIND IT? >> I LIKED IT. I MEAN, IT IS SOMETHING I WOULD USE IN THE DENTAL OFFICE. >> OKAY. DIDN'T FEEL UNCOMFORTABLE AT ALL? >> NOT AT ALL. >> MANY PATIENTS REPORT EXPERIENCING DIZZINESS, A STOMACH UPSET, OR THEY HAVE EXPERIENCED THAT, AND AGAIN, GENERALLY, THOSE HAVE BEEN SIGNS THAT THEY HAVE BEEN OVER-SEDATED. WE USE-- AND YOU WILL BE TAUGHT THE TITRATION TECHNIQUE WHERE WE ARE JUST ADDING A LITTLE BIT OF NITROUS PERIODICALLY EVERY MINUTE OR SO UNTIL WE ACHIEVE JUST THE AMOUNT OF SEDATION WE NEED. TRY TO AVOID THE "FIXED DOSE" TECHNIQUE. A NUMBER OF PRACTITIONERS WILL USE THE "FIXED DOSE" TECHNIQUE. IN OTHER WORDS, EVERYONE GETS 40% NITROUS OXIDE, 60% OXYGEN. IN THOSE CASES, THAT IS WHEN PEOPLE BEGIN TO FEEL OVER-SEDATED, SICK TO THEIR STOMACH, DIZZY, FLOATING, AND SO ON. SO... GREAT JOB. THANK YOU VERY, VERY MUCH FOR LETTING US DO THIS. >> NO PROBLEM. >> YOU ARE JUST A PEACH. SO WE WILL GO AHEAD AND WE WILL REMOVE THE NASAL HOOD. GREAT. WE CAN TURN OFF THE OXYGEN. WE CAN TURN OFF THE SUCTION, AND SLOWLY SIT THE CHAIR BACK UP. (music) GREAT. SO THANK YOU FOR LETTING ME CARE FOR YOU, KYRA. YOU CAN GO AHEAD AND DO WHAT YOU WOULD NORMALLY DO TODAY. SO SCHOOL WORK, WORK, HOME, WHATEVER YOU WERE GOING TO DO, BY ALL MEANS JUST GO RIGHT AHEAD. >> OKAY. >> ALL RIGHT... THANK YOU. >> THANK YOU. >> YOU ARE WELCOME. YOU ARE WELCOME. (music)