I’ve written before about how the current standard of care is to provide some sort of sedation drugs — by mouth or by injection — to relieve pain and anxiety when we have to do things to children that make them uncomfortable, such as sewing up lacerations or doing x-ray studies that require them to lay still for a prolonged period. Pediatric intensivists in particular have become very involved in providing this service for children. There’s even a new professional organization, the Society for Pediatric Sedation, that gathers together doctors and nurses involved in this practice. (I’m a member.)
We have a menu of medications to choose from, but finding the perfect sedative for children is sometimes difficult. All of them have potential issues, although we are used to dealing with these things. Recently there’s been a new agent on the pediatric sedation scene, although it’s been around for many years for other uses — nitrous oxide, aka “laughing gas.” It’s been used in the operating room for many decades as a supplement to more potent anesthetics, and outside the operating room in dental offices for well over a century. It has an outstanding safety profile. One of the pioneers in using nitrous oxide for sedating children for medical procedures is Dr. Judy Zier, of Minneapolis Children’s Hospital. For the past year we’ve been using nitrous oxide at my hospital, and for many children it is very helpful. It seems to be most helpful for children between about two years of age and ten or so. We now typically use it for many things we just used to do without any sedation at all — placing intravenous (IV) lines, urinary catheters, and nasogastric tubes. I think it represents a real advance in what we can offer children. Being in the hospital is frightening enough for a child.