Nitrous Oxide Increases Patient Comfort For In-Office Procedures & Surgery


Anxiety, including needle phobia, is a reality and even a precluding factor for many patients who undergo surgical or even nonsurgical cosmetic procedures. To address patient discomfort,  plastic surgeon Chris Nichols MD., says he uses nitrous oxide (laughing gas) as a supplement to local anesthesia and oral sedation. 

Mixed with oxygen, nitrous oxide is a safe and effective sedative that, when breathed in, helps people relax, according to the American Dental Association. Researchers Reported on the use of nitrous oxide in 24 cosmetic dermatology patients in 2013. They found lower subjective pain intensity among those treated with nitrous oxide and all but one of the people studied chose nitrous oxide for their next treatment.

Dr. Nichols, who has a surgical and nonsurgical cosmetic practice in the Olympia, WA, says nitrous oxide has been accepted with high patient satisfaction during injections, resurfacing, and even for his office-based surgeries. He uses nitrous oxide, with or without topical anesthetic and local injection anesthesia, for patients who are particularly anxious.

Some patients either have a very low pain threshold or have anxiety and they find the laughing gas to greatly improve their experience. Dentists use nitrous oxide delivery systems with nasal prongs or a mask in a continuous flow manner, but cosmetic surgeons often work in this area and the prongs can get in the way and continuous nitrous oxide can require more intense patient monitoring. Nitro-Nox devised a device that makes it possible for plastic surgeons to use laughing gas in their offices unhindered and it is completely patient administered.

 Patients put a plastic mouthpiece in and breathe the gas in through their mouths a few times and breathe it out through their mouths. II can then perform local anesthetic nerve or field blocks or aesthetic injections and pause and have the patient breathe again a few times and keep doing the treatment. 

Patient recovery is fast.

Laughing gas’s effects only last a few minutes, according to Dr. Nichols. If a patient has only had the laughing gas and no other IV or oral sedation then they can drive on their own after just 10-15 minutes. Pulmonary disease patients are among those who aren’t candidates, and if oral/IV sedation has been given or if the vision has been temporarily impacted by the treatment or surgery we always require a driver for patient safety.

Needle phobia is not necessarily connected to pain; it’s often mostly connected to anxiety. Nitrous Oxide, which is safe and easy to use, really tackles anxiety,” but we have found for lengthy or more painful procedures that it best to still give an amnestic oral sedative agent in addition to maximize the patient experience. Many patients don’t want an IV or general anesthesia and we now have another tool to make patient anxiety and comfort even better. As far, as we know we are the only surgical and med-spa practice in Olympia offering this device.  It was a no-brainer purchase decision, and we are proud to offer this to our Pearl Plastic Surgery patients.




What is nitrous oxide?

Nitrous oxide is a safe and effective anxiolytic and analgesic agent that is mixed with oxygen. Nitrous oxide is used during procedures and treatments to help make you feel more comfortable. 


How does the nitrous and oxygen analgesia system work?

The nitrous oxide and oxygen analgesia system delivers a safe mixture of nitrous oxide and oxygen which is inhaled through a mouthpiece or mask, providing you control over self-administration. Your doctor will ask you to breathe normally through your mouth, and within a few short minutes you should start to feel the effects of the gas mixture. The effects of nitrous oxide wear off within 5-10 minutes after the last inhalation of the N2O/O2 mixture. 


Will this put you to sleep?

No. The provided nitrous oxide and oxygen ratio is not strong enough to provide anesthesia and put you to sleep. You will be able to hear and respond to any requests or directions the doctors may have. 


How will I feel while using nitrous oxide?


Most patients will say it makes them feel relaxed, and their arms and legs feel light. Some patients feel tingling in their extremities and report feeling like they are floating, and/or sinking. As nitrous oxide is often called “laughing gas”, some patients will feel giggly when the gas mixture takes effect. Moreover, your voice may temporarily change during the administration of nitrous oxide since vocal cords are affected by nitrous oxide. 


How fast does nitrous oxide take effect and last?

For most patients, the calming, relaxing effects of nitrous oxide will be felt within a minute or two or after a couple of deep inhalation/exhalation cycles. Effects may vary from patient to patient. Once you stop inhaling the gas mixture, you will start feeling back to normal within 5-10 minutes. 


Can I drive home after using nitrous oxide? 

This is dependent upon the procedure performed, other medications administered, etc. The effects of nitrous oxide and oxygen on their own are completely out of your system within a few minutes. It is reasonable that you can safely go home about 10 minutes after ceasing use of nitrous oxide and oxygen assuming all other discharge criteria have been met.


Does nitrous oxide eliminate pain?

Nitrous oxide does not eliminate pain. This is important to understand and to set your expectations. This will also not replace an anesthetic which is often used to numb locally (if required). Nitrous oxide is intended to take the edge off, help you relax, make you feel more comfortable, and reduce anxiety. This is not something you would use for extremely painful procedures.

Is nitrous oxide safe?

Nitrous oxide has been used for over 100 years [1] and has a long-standing safety record. When the Nitronox device is used, you are awake (conscious), responsive, and breathing normally on your own. 


What are the typical side effects that one might feel?

Side effects are usually minimal. With a self administered protocol, you are in total control minimizing side effects. Side effects that can occur in some patients are dizziness and nausea. If you do not like how you are feeling, stop inhaling the N2O/O2 mixture and breathe room air. This should quickly reverse any negative effects. 


Benefits and Advantages

  • Provides comfort and reduces anxiety
  • Self-administered
  • Fast acting
  • Quick recovery 
  • Alternative for oral medications and opioids


We’d love to chat with you about NitroNox. We will help you explore your options for comfortable Facial Rejuvenation options at Pearl Plastic Surgery. Contact us today to schedule your consultation!

Find out more about our Location and Scheduling.



[1]Nitrous Oxide for the Management of Labor Analgesia. AANA Journal, February 2018, Vol. 86, No. 1

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