The environmental impact of free-flow versus on-demand gas release for dental inhalation sedation

Aim To evaluate three clinical techniques (current practice, Silhouette with a flow rate protocol, and eAdvantage) for inhalation sedation. Methods This study was conducted at the Eastman Dental Hospital (London, UK) using quality improvement methodology. The three clinical techniques were used over a six-week period. Data were collected on the volume of nitrous oxide (N 2 O) gas used per patient, success rate, as well as patient and staff feedback. Results Ninety-eight episodes of inhalation sedation were observed during the pilot period. Both Silhouette and eAdvantage techniques demonstrated impressive reductions in the volume of N 2 O used per patient (58% and 70%, respectively) when compared to current practice. The success rate was 97% for current practice and eAdvantage, and 86% for Silhouette. Conclusion Current practice for inhalation sedation relies on a flow rate that is set by the clinical team, with the patient breathing from a reservoir of gas. This technique is potentially over-delivering gas, and new techniques and equipment that reduce or eliminate this free-flow rate show significant environmental benefits.