Clinical Performance of Nitrous Oxide Inhalation versus Intravenous Sedation in Outpatient Dental Surgery: Efficacy and Safety Outcomes

Abstract

Selecting an optimal sedation technique is pivotal for balancing efficacy and safety in outpatient dental surgery. Nitrous oxide inhalation and intravenous sedation are widely used, yet comprehensive comparative data in similar clinical environments are needed to guide practice. The objective of this study was to prospectively compare the clinical efficacy, safety, and recovery profiles of nitrous oxide inhalation sedation versus intravenous midazolam sedation for outpatient dental surgical procedures. This prospective cohort study was conducted at Liberty Hospital Ltd. Paribagh, Shahbagh, Dhaka, Bangladesh, from January to December 2024. A purposive sample of 50 patients was allocated to receive either nitrous oxide/oxygen (n=25) or intravenous midazolam sedation (n=25). Efficacy was measured by procedure completion, operator satisfaction (10-point VAS), and patient-reported anxiety reduction. Safety outcomes included hemodynamic stability, adverse event incidence, and time to meet a modified Aldrete recovery score of ≥9. Data were analyzed using SPSS version 23.0. Both techniques achieved 100% procedure completion. Intravenous sedation provided superior operator satisfaction and greater anxiety reduction (p<0.001). However, nitrous oxide yielded a significantly faster recovery time (8.5 vs. 33.1 minutes, p<0.001) and lower rates of postoperative nausea (8.0% vs. 36.0%, p=0.021) and hypotension (4.0% vs. 32.0%, p=0.019). Hemodynamic changes were more pronounced with IV sedation. Intravenous sedation is optimal for profound anxiolysis in complex cases, while nitrous oxide is ideal for routine procedures, prioritizing rapid recovery and fewer side effects. The choice should be individualized based on patient factors and procedural demands.  

CBMJ 2026 July: Vol. 15 No. 02 P:283-289