Understanding Nurses' and Physicians' Knowledge, Use and Perspectives on Nitrous Oxide/Oxygen Use in Paediatrics: A Cross-Sectional Study

Nurs Crit Care. 2026 Mar;31(2):e70360. doi: 10.1111/nicc.70360.

Abstract

Background: Nitrous oxide/oxygen (N2O/O2 50%/50%) is an effective and safe technique for procedural sedation in paediatric settings; however, the knowledge, use and perspectives of healthcare professionals regarding N2O/O2 remain limited.

Aim: To investigate the knowledge, use and perspectives of healthcare professionals regarding N2O/O2 in maternal-infant and emergency units.

Study design: A cross-sectional study was conducted (March to December 2024) using (i) a sociodemographic information tool and (ii) a 16-item questionnaire assessing knowledge, clinical use, perceived barriers and willingness to adopt N2O/O2. Descriptive and multivariate analyses were performed.

Results: Of 113 respondents, 40.7% reported currently using N2O/O2 in their clinical units, while 91.0% of non-users expressed willingness to adopt it. Barriers included lack of equipment (92.9%) and training (84.1%). 91.1% considered N2O/O2 ethically acceptable, consistent with principles of beneficence, non-maleficence and child comfort. Employment in emergency units and holding a three-year nursing degree were significant predictors of N2O/O2 use.

Conclusions: Limited Use of N2O/O2 in Italian Paediatrics Contrasts With Strong Professional Interest. Improving Training and Resources Could Enhance Access to Safe Paediatric Sedation.

Relevance to clinical practice: Training, equipment and guidelines are needed to translate willingness into real clinical practice, improving the safety and consistency of paediatric sedation.

Keywords: conscious sedation; cross‐sectional study; inhalation analgesia; nitrous oxide; paediatric emergency medicine.

MeSH terms

  • Adult
  • Anesthetics, Inhalation
  • Attitude of Health Personnel*
  • Child
  • Cross-Sectional Studies
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Male
  • Middle Aged
  • Nitrous Oxide* / administration & dosage
  • Nitrous Oxide* / therapeutic use
  • Oxygen* / administration & dosage
  • Oxygen* / therapeutic use
  • Pediatrics
  • Physicians* / psychology
  • Procedural Sedation* / methods
  • Surveys and Questionnaires

Substances

  • Nitrous Oxide
  • Oxygen
  • Anesthetics, Inhalation