Risk of respiratory depression at use of nitrous oxide on individuals with cerebral palsy: a clinical trial





Cerebral palsy; Dental care; Conscious sedation; Nitrous oxide.


The dental care for individuals with cerebral palsy (CP) often result in the referral of patients for general anesthesia. Conscious sedation with nitrous oxide (N2O) could be an alternative resource, from a behavioral and physiological point of view, and could favor dental care in an outpatient setting. This study aimed to evaluate the influence of conscious sedation with N2O on respiratory rate (RR) and oxygen saturation (SpO2) in the dental treatment of individuals with CP. Seventy-seven patients with CP, over 3 years old, regardless of gender and ethnicity, were evaluated with the measurement of N2O titration, RR and SpO2 in four moments: initial, 5 minutes after sedation, 10 minutes after anesthesia and 5 minutes after removal of the N2O. Student's t test and ANOVA F were used, with a significance level of 5%. The variation in N2O titration did not generate significant variation in RR (p = 0.122). There was a significant difference in SpO2 between T1 and other times. It can be said that conscious sedation is not influenced by N2O titration, does not cause respiratory depression or any clinically significant change in SpO2, confirming the safety of use in an outpatient setting.


Ahmad, R., Rahman, N. A., Hasan, R., Yaacob, N. S. & Ali, S. H. (2020). Oral Health and Nutritional Status of Children With Cerebral Palsy in Northeastern Peninsular Malaysia. Spec Care Dentist. 40 (1), 62-70.

Akhter, R., Hassan, N. M. M., Martin, E. F., Muhit, M., Rahman, R., Smithers-Sheedy, H., et al. (2017) Risk factors for dental caries among children with cerebral palsy in a low‐resource setting. Dev Med Child Neurol. 59 (5), 538‐43.

Ashley, P. F., Chaudhary, M. & Lourenço-Matharu, L. (2018). Sedation of Children Undergoing Dental Treatment. Cochrane Database Syst Rev. 12 (12), CD003877.

Baeder, F. M., Figueirêdo, L. P. & Dos Santos, M. T. B. (2015). Estudo comparativo entre enzimas utilizadas no metabolismo de medicamentos em pacientes com paralisia cerebral e anestésicos odontológicos. Full Dentistry Science. 6 (22), 234-8.

Baeder, F. M., Silva, D. F., Albuquerque, A. C. L. & Santos, M. T. B. R. (2017). Conscious Sedation with Nitrous Oxide to control Stress during Dental Treatment in Patients with Cerebral Palsy: An Experimental Clinical Trial. Int J Clin Pediatr Dent. 10 (4), 384-90.

Bonafé-Monzó, N., Rojo-Moreno, J. & Catalá-Pizarro, M. (2015). Analgesic and physiological effects in conscious sedation with different nitrous oxide concentrations. J Clin Exp Dent. 7 (1), e63-8.

Brondani, J. T., Nataline, C. C., Pippi, N. L., Massanti, A., Prati, L., & Bertin, A. P. (2003). Ketamine, midazolam and nitrous oxide anesthesia in dogs submitted to cervical esophagoplasty. Cienc Rural. 33 (6), 1075-80.

Cantador-Hornero, M., Jiménez-Espuch, P., Torres-Garcia, I., Contreras-Jiménez, M., Martínez-Mezo, G. L., Santos, J. M. M., et al. (2019). Protocolo sedoanalgésico para la infiltración de toxina botulínica A en parálisis cerebral. An Pediatr (Barc). 91 (5), 317-27.

Cardona-Soria, S., Cahuana-Cárdenas, A., Rivera-Baró, A., Miranda-Rius, J., Carpi, J. M. & Brunet-Lloblet, L. (2020). Oral Health Status in Pediatric Patients With Cerebral Palsy Fed by Oral Versus Enteral Route. Spec Care Dentist. 40 (1), 35-40.

Dai, Y. L., Chai, X. M., Zhu, N., Wang, K. B., Bao, W. Q., Zhang, X. S., et al. (2019). Analgesia effect of premixed nitrous oxide/oxygen during the rehabilitation after total knee arthroplasty: a study protocol for a randomized controlled trial. Trials. 20 (1), 399.

Done, V., Kotha, R., Vasa, A. A. K., Sahana, S., Jadadoddi, R. K., & Bezawada, S. (2016). A Comparison of the Effectiveness of Oral Midazolam - N2O Versus Oral Ketamine - N2O in Pediatric Patients-An in-Vivo Study. J Clin Diagn Res. 10 (4), ZC45-8.

Drosner, M. (2013). Nitrous oxide-oxygen analgesia in aesthetic dermatology. Hautarzt. 64 (6), 435-42.

Galeotti, A., Garret Bernardin, A., D’Antò, V., Ferrazzano, G. F., Gentile, T., Viarani, V., et al. (2016). Inhalation Conscious Sedation with Nitrous Oxide and Oxygen as Alternative to General Anesthesia in Precooperative, Fearful, and Disabled Pediatric Dental Patients: A Large Survey on 688 Working Sessions. Biomed Res Int. 2016, 7289310.

Guimarães, C. C., Lopes Motta, R. H., Bergamaschi, C. C., Araújo, J. O., Andrade, N. K., Figueiró, M. F., et al. (2017). Local anaesthetics combined with vasoconstrictors in patients with cardiovascular disease undergoing dental procedures: systematic review and meta-analysis protocol. BMJ Open. 7 (11), e014611.

Jay, M. A., Thomas, B. M., Nandi, R. & Howard, R. F. (2017). Higher risk of opioid-induced respiratory depression in children with neurodevelopmental disability: a retrospective cohort study of 12 904 patients. Br J Anaesth. 118 (2), 239-46.

Jan, B. M. & Jan, M. M. (2016). Dental health of children with cerebral palsy. Neurosciences (Riyadh). 21 (4), 314-8.

Li, L., Pan, Q., Xu, L., Lin, R., Dai, J., Chen, X., et al. (2019). Comparison of analgesic and anxiolytic effects of nitrous oxide in burn wound treatment: A single-blind prospective randomized controlled trial. Medicine (Baltimore). 98 (51), e18188.

Mandaleson, A., Lee, Y., Kerr, C. & Graham, H. K. (2015). Classifying Cerebral Palsy: Are We Nearly There? J Pediatr Orthop. 35 (2), 162-6.

Prud’homme, T., Allio, A., Dajean-Trutaud, S., Bulteau, S., Rousselet, M., Lopez-Cazaux, S., et al. (2019). Assessment of an Equimolar Mixture of Oxygen and Nitrous Oxide: Effects in Pediatric Dentistry. Int J Clin Pediatr Dent. 12 (5), 429-36.

Sacoor, S. (2017). Anaesthesia and Sedation for the Autistic Patient. SAAD Dig. 33 (1), 40-3.

Sedky, N. A. (2018). Assessment of oral and dental health status in children with cerebral palsy: An exploratory study. Int J Health Sci (Qassim). 12 (1), 4-14.

Shaikh, S. I. & Hegade, G. (2017). Role of Anesthesiologist in the Management of a Child with Cerebral Palsy. Anesth Essays Res. 11 (3), 544-9.

Stevens, W. C., Dolan, W. M., Gibbons, R. T., White, A., Eger, E. I., Miller, R. D. et al. (1975). Minimum alveolar concentrations (MAC) of isoflurande with and without nitrous oxide in patients of various ages. Anesthesiology. 42 (2),197-200.

Wimalasundera, N. & Stevenson, V. L. (2016). Cerebral Palsy. Pract Neurol. 16 (3), 184-94.

World Health Organization. (1997). Oral health surveys: basic methods. (4th ed.), ORH/EPID. 53-62.




How to Cite

BAEDER, F. M.; SILVA, D. F. .; ALBUQUERQUE, A. C. L. de; SANTOS, D. C. L. dos .; PAVANELLO, A.; DAVID, A. F.; SANTOS, M. T. B. R. . Risk of respiratory depression at use of nitrous oxide on individuals with cerebral palsy: a clinical trial . Research, Society and Development, [S. l.], v. 10, n. 13, p. e198101320774, 2021. DOI: 10.33448/rsd-v10i13.20774. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/20774. Acesso em: 16 jan. 2022.



Health Sciences