MVH uses nitrous oxide to bring patients quick pain relief

Federal funds will be used to expand treatment, update critical care equipment.

Katie Forand demonstrates how the nitrous oxide machine works with her daughter, Emma. —Courtesy MVH

As part of a federal spending bill recently signed by President Joe Biden, Massachusetts Sens. Elizabeth Warren and Ed Markey helped secure much-needed funds for Martha’s Vineyard Hospital.

The federal money will assist the hospital in meeting the growing demand for healthcare on the Island for both its residents and visitors. The funds will be used to update equipment for the operating room, acute-care unit, and the radiology department, as well as expanding its use of nitrous oxide.

The hospital first introduced nitrous oxide as a treatment for severe pain, particularly for pediatric patients, in the Emergency Department last year.

Dena Kostka, a physician assistant in the Emergency Department, spearheaded the program at Martha’s Vineyard Hospital after previously using the treatment in the pediatric ER at Newton- Wellesley Hospital.

The nitrous oxide delivery system is a pneumatically driven gas mixer designed to deliver a mixture of 50 percent oxygen and 50 percent nitrous oxide to patients to relieve moderate and temporary pain, and to decrease anxiety. It takes effect quickly (50 to 60 seconds), with variable pain relief, and has a rapid clearance, with a half-life of about five minutes. It acts as an anxiolytic, leaving the ventilatory and circulatory functions unaffected.

“Many times, other forms of pain control, such as lidocaine for anesthetizing a wound, are still needed prior to suturing, but the nitrous makes the injection less painful, and the remainder of the procedure less stressful, particularly for small children,” said Kostka, who began moonlighting at Martha’s Vineyard Hospital in 2017, and came aboard full-time in 2019. “I found nitrous to be an invaluable tool for helping patients with anxiety through otherwise painful procedures, without needing to be sedated.”

The machine used to deliver nitrous oxide is kept in the Emergency Department, but it can be used in Maternity as well.

“Having nitrous available has multiple advantages: most importantly, improved patient experience in regard to decreasing anxiety and pain associated with certain procedures, or the ER experience in general,” said Kostka.

Other advantages include:

  • Shorter door-to-discharge times, as the recovery after nitrous is minimal.
  • Less use of opiate pain medication/benzodiazepines.
  • Alternative to full or conscious sedation.
  • Maximizes staffing throughout the department.
  • Can be used in patients over 12 months old.
  • Extremely safe, with a low side-effect profile.

Prior to nitrous, ED staff would utilize more antianxiety medications, conscious or full sedation, as well as the “baby burrito technique,” where the child is wrapped in a sheet to minimize movement. While that technique is still sometimes needed, nitrous can provide pain relief for children over a year old.

The federal funding will also add 10 telemetry units in the hospital’s acute-care wing to allow for continuous heart monitoring for at-risk patients. The hospital currently has three telemetry units, which have been dedicated to the Intensive Care Unit and Emergency Department.

The funds will also be used to purchase a fiber-optic surgical system that will help surgeons navigate lighting and imaging, as well as purchasing a fluoroscopy unit, which will increase the hospital’s digital imaging capability, allowing faster results and better access for patients.

“These investments, made possible through federal funds, include equipment and infrastructure that will help us better confront significant challenges, including increased inpatient admissions for behavioral health, longer postsurgical stays, and patients with more acute illnesses,” said Claire Seguin, chief nurse and vice president of operations.

Health Beat is sponsored by Martha’s Vineyard Hospital. It informs and advises on health issues, shares health tips, and helps the community to become better acquainted with Martha’s Vineyard Hospital, the physicians, and staff. For more information, visit