Best answer is c.
COPD represents a relative contraindication to inhalation sedation, not because of the nitrous oxide, but because the gas mixture is enriched with oxygen. Patients with COPD have lost their ability to respond to elevated carbon dioxide levels in the blood as their primary stimulus to breath. Instead they respond to decreased blood oxygen content. Theoretically these patients should experience apnea when given nitrous oxide/ oxygen sedation. This does not occur in the conscious individual since voluntary control over breathing is possible.
Nitrous oxide is not metabolized by the liver or excreted through the kidneys, therefore hepatic and renal disease do not contraindicate its use.
Nitrous oxide/oxygen sedation is actually the preferred method of sedation for patients with a history of cerebral vascular accident because of the increased oxygen levels that are provided.
In our litigious society , the performance of any elective dental treatment or administration of any pharmacological agent to a pregnant patient may be legally contraindicated. However, there is no medical reason against using nitrous oxide/oxygen sedation after the first trimester.
Ref: Malamed, emergency in the Dental Office pp. 175-176.
Allen, p 267.
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