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Pediatric Office Procedures with PRO-NOX™ Nitrous Oxide


An 8-year-old girl presents with a 1 year history of dark mole of the right lower eyelid. Initially presenting as a small freckle, it grew and darkened in color. Right lower eyelid excisional biopsy was performed utilizing PRO-NOX™ nitrous oxide system. Biopsy showed intradermal nevus, combined type (primarily a common blue nevus and a minor component of a deep penetrating nevus).

Before and after removal of nevus on pediatric patient.


Pediatric patients present a challenge for dermatologists and plastic surgeons when office surgical treatment is required. Unlike adults, children often require the operating room with anesthesia sedation when a simple excision is required. Office-administered nitrous oxide is changing that. PRO-NOX™ nitrous oxide system is bringing analgesia and light sedation into the office setting. The machine is simply a control valve that mixes oxygen with nitrous oxide as a 50:50 mixture. The flow is dependent upon the patient’s inhalation effort, while providing no passive flow. This eliminates the need for gas scavenging systems in the office. The patient- controlled sedation avoids over-sedation or loss of protective reflexes and eliminates the need for monitoring. Pediatric procedures become more tolerated in the office setting.

This photo shows a pediatric patient using PRO-NOX™. 
This is not the patient featured in this case study.

The treatment involves having the patient take 3 deep breaths while sucking on the PRO-NOX™ tubing. The effect is felt after 3 breaths. In many patients, 5 breaths are required for the desired result. Holding the breath at the peak of inhalation maximizes nitrous oxide absorption. Repeat inhalations may be required after 3 minutes as the effect wears off quickly. Our adult patients can drive 30 minutes after the last inhalation. In some patients, more than 5 breaths may cause brief nausea.

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