Nitrous Oxide Use in Autistic Children

OBJECTIVES: Describe the population of autistic children who undergo nitrous oxide sedation and the rate of associated adverse events (AEs). Analyze patient- and procedure-level factors associated with AEs in autistic children receiving nitrous oxide outside the dental setting. METHODS: A retrospective, descriptive study of autistic children, 3 to 18 years, who received nitrous oxide for procedural sedation during an emergency department or sedation encounter within a single hospital system between January 2014 and December 2023. Data extracted included patient demographics and comorbidities, as well as indication, maximum concentration, duration of administration, and AEs of nitrous oxide. Descriptive statistics were used to summarize the data. RESULTS: Analysis was performed on 186 patients [median age: 8 years (interquartile range: 5.2-12.75), 74.2% male]. Intravenous line placement was the most common indication in all locations. Most received 70% nitrous oxide with a median duration of 6 minutes (interquartile range: 4 -9.75). AEs were rare, occurring in only 3 patients (1.6%), with zero vomiting or aborted procedures. Given the rarity of AEs, no associated factors were able to be identified. CONCLUSIONS: Nitrous oxide is a safe, effective, and well-tolerated option for procedural sedation in autistic children, with a low rate of AEs. These findings add to the limited literature supporting its use in nondental settings and suggest it may be a valuable tool for facilitating minor procedures in this population. Future prospective studies are needed to optimize nitrous oxide delivery and determine factors contributing to AEs.