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Nitrous oxide gas is used in both the medical and dental professions to ensure patient comfort during procedures. In medicine, a 40%-70% N2O mixture (the remainder consisting of oxygen) is used as an adjunct to inhalation and IV general anesthesia. The gaseous mixture is administered using either a mask or an endotracheal tube. Nitrous is useful in medicine due to its relative fast rate of induction. The onset of action for N2O is between 2-5 minutes. However, since the mean alveolar concentration (MAC) of N2O considered the ED50 for general anesthesia (the dose at which 50% of patients will experience anesthesia) is 105%, nitrous cannot be used alone as a general anesthetic. Typically, it is only used to help start the process.
In dentistry, nitrous oxide is typically used as an anxiolytic. It is given in a 25%-50% mixture with oxygen. Most often it is administered through a nasal mask.  The patient should be started out breathing 100% oxygen and then slowly allowed to breath increasing amounts of N2O until the desired effect is achieved. It is important that the patient be reminded to breathe through the nose in order for the gas to work. The patient should be questioned as to how they are feeling to ensure an optimal level of nitrous is being administered. Therapeutic levels will vary from patient to patient. If the nitrous level being administered is too low, the patient will not be receiving an effective anxiolytic dose. If the nitrous level is too high, unwanted side effects may occur. After the procedure is finished, allow the patient to breathe 100% oxygen again for 2-5 minutes in order to clear the nitrous from the lungs and return the patient to a normal feeling.
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