31 March 2025
Relative analgesia and conscious sedation
Relative analgesia
The Dental Consultant service recently received a call from a technician involved in the servicing of relative analgesia (RA) equipment. He had attended a practice that had RA equipment that was 20 years old, and it had been some time since the equipment had been serviced. One machine was allowing 100% nitrous oxide.
A review of the ADA Guidelines and indicates that RA equipment should be serviced periodically, ideally annually and is supported by ANZCA (Australian and New Zealand College of Anaesthetists) PS54.
ADA Guidelines for the Administration of Nitrous Oxide and Oxygen Relative Analgesia in Dentistry
ADA Policy Statement 6.33 – Nitrous Oxide Sedation in Dentistry
Only dentists who have adequate training and experience should administer nitrous oxide as a form of anxiolysis (minimal sedation) for dental procedures.
ADAVB runs courses for training in relative analgesia and they are always well attended. The next one with availability for attendance one can be found at the link provided: adavb.org/event/relative-analgesia-25-10-24
Conscious sedation
Nitrous oxide and oxygen relative analgesia is recognised as a very safe technique given that it has minimal effects on the cardiovascular system. However, its use in combination with other drugs may potentiate their effects. Therefore, nitrous oxide inhalation should not be used in combination with drugs where a patient may have other risk factors unless administered by a dentist endorsed to perform conscious sedation, a medical practitioner or an anaesthetist. This means combining nitrous oxide with benzodiazepines or other sedating medications is considered as conscious sedation and should not be practised unless you have a conscious sedation endorsement. The DBA provides information on courses that are recognised to provide this education and application is then required for endorsement to provide this type of sedation. Dental Board of Australia - Conscious Sedation
Please be aware that the use of methoxyflurane (the green whistle or Penthrox) is not recommended as a minimal sedation technique in dentistry, see TTherapeutic Guidelines Oral and Dental Version 3.
For further information re recent updates for RA equipment and legislation regarding sedation there is an informative CPD video available here: portal.ada.org.au/Portal/Shared_Content/Smart-Suite/Smart-Video/Public/CPD-Library-Video-Player.aspx?videoId=590
24 Oct
Nitrous oxide administration OCTOBER
Presented by Dr Greg Mahoney and Dr Wessam Atteya
Gain or update your skills in the administration of nitrous oxide (relative analgesia) as part of your clinical practice.
