The Danish Medical Journal (DMJ) is a general medical journal published by The Danish Medical Association. The journal publish peer reviewed original research in English – conducted in or in relation to the Danish health-care system. All articles are open access.

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Original Article

Several Cochrane analyses were excluded due to this criterion. Additional searches were performed from the reference lists of the selected literature.
After this procedure, a total of 26 studies were selected for review (see PRISMA flow diagram in Figure 1).
RESULTS
The results from this systematic review are presented under the following subheadings: “Classical strategies for pain relief”, “The optimal duration of inhalation and concentration of nitrous oxide” and “Effectiveness of nitrous oxide during different procedures”.
Classical strategies for pain relief
Non-pharmacological treatments
The predominant strategies are cognitive behavioural therapy [12], use of music [13] or topical freeze sprays [14].
Pharmacological treatments
An ideal agent for children should be easy to administer, have a rapid onset and offset, produce no residual symptoms, have minimal side effects, and should be cost-effective. Pharmacological options for children are available in different forms classified as invasive or non- invasive drugs. In Denmark, either eutectic mixture of local analgetics (EMLA), midazolam or nitrous oxide or a combination of these has typically been used.
Topical anaesthesia
EMLA cream the most frequently used anaesthetic cream in Scandinavia. It contains two dermal anaesthetics: lidocaine and prilocaine [15].
Orally, nasally and rectally administered sedatives
In Denmark, benzodiazepines have typically been used, and midazolam has become more popular than other benzodiazepines as it has a shorter half-life and is more potent than the alternatives [16, 17]. Rectal administration has primarily been used, but midazolam can also be administered orally [18], intranasally, buccally, intravenously or intramuscularly. The main effects of benzodiazepines are sedation, hypnosis, anxiolysis, anterograde and retrogade amnesia, centrally mediated muscle relaxation and anti-convulsant activity [19, 20]. Although the efficacy of midazolam has been demonstrated, the inter-

DMJ 6/2013

4627_samletkonflikter.pdf

a4627.pdf

Nitrous oxide provides safe and effective analgesia for minor paediatric procedures – a systematic review

Nitrous oxide provides safe and effective analgesia for minor paediatric procedures – a systematic review

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