Intravenous Conscious Sedation Dentistry (aka “IV sedation”) is when a drug, usually of the anti-anxiety variety, is administered into the blood system preceding dental treatment.
What does it feel like? Will I be asleep?
In reality, you remain conscious during conscious IV sedation. You will also be able to understand and respond to requests.
However, you may not remember much (or anything at all) about what went on because of two things:
1. IV sedation induces a state of deep relaxation and a feeling of not being bothered by what’s going on.
2. The drugs used for IV sedation produce either partial or full memory loss (amnesia) for the period of time when the drug first kicks in until it wears off. As a result, time will appear to pass very quickly and you will not recall much of what happened. Many people remember nothing at all. So it may, indeed, appear as if you were “asleep” during the procedure.
First-hand accounts of IV sedation from the DentalFearCentre.org:
“Basically, it’s just a tiny pinch in the back of the hand and in goes the ‘stuff’. Nothing happens for several seconds and then you begin to feel light-headed (a little drunk) for a few moments, which is not unpleasant. Then instantly several hours have magically passed and everything has been done. It’s like the flick of a switch, which turns your brain off for an hour or two. You feel fairly dopey and woozy afterwards where you may want to go and sleep it off.”
“Well, I DID IT!!!!!!!! … As I sat in the chair, I could feel my heart racing and remember telling the dentist that I needed to do this… I didn’t feel the IV being inserted, and as he was topping up the sedation level, he gave me the local injections, now this should be freaking me out, but honestly, I only felt a scratch!! And me being needle phobic too! And just to quell any fears about infection being present throughout extraction: The infection I’ve had on and off for months now came back with a vengeance last night and I NEVER felt it being extracted. Next thing I knew I was in the little recovery room with my partner.”
Is it still necessary to be numbed with local anaesthetic?
The drugs which are usually used for IV sedation are not painkillers but anti-anxiety drugs. While they relax you and make you forget what happens, you will still need to be numbed.
If you have a fear of injections, you will not be numbed until the IV sedation has fully kicked in. If you have a phobia of needles, you will very probably be relaxed enough not to care by this stage.
How is IV sedation given?
“Intravenous” means that the drug is put into a vein. An extremely thin needle is put into a vein close to the surface of the skin in either the arm or the back of your hand.
Throughout the procedure, your pulse and oxygen levels are measured using a pulse oximeter. This gadget clips onto a finger or an earlobe and measures pulse and oxygen saturation. Blood pressure before and after the procedure are checked with a blood pressure measuring machine.
What are the Drugs that are used?
There are quite a few other drugs that can be used for IV sedation. But in practical terms, most of the time a single benzodiazepine, usually midazolam, is used. A typical IV session takes up to 1 1/2 hours.
The general consensus among the leading experts in the field of dental sedation today is: the fewer medications are used, the safer the treatment tends to be (and the easier it is to track any potential problems). Usually, this means one medication only. Midazolam tends to be the drug of choice.
Is it safe? Are there any contraindications?
IV sedation is extremely safe when carried out under the supervision of a specially-trained dentist. All our treating dentists have done an 18 month training course in the Dublin Dental Hospital for conscious sedation. However, contraindications include
• Known allergy to benzodiazepines
• Alcohol intoxication
• Cns depression, and
• Some instances of glaucoma.
What are the main advantages of IV sedation?
• IV sedation tends to be the method of choice if you don’t want to be aware of the procedure – you “don’t want to know”.
• The onset of action is very rapid, and drug dosage and level of sedation can be tailored to meet the individual’s needs. This is a huge advantage compared to oral sedation, where the effects can be very unreliable. IV sedation, on the other hand, is both highly effective and highly reliable.
• The maximum level of sedation which can be reached with IV is deeper than with oral or inhalation sedation.
• Benzodiazepines produce amnesia for the procedure.
• The gag reflex is diminished
• Unlike General Anaesthesia or Deep Sedation, conscious IV sedation doesn’t really introduce any compromises per se in terms of carrying out the actual procedures because people are conscious and they can cooperate with instructions, and there is no airway tube involved.
After IV Sedation:
1 Have your escort take you home and rest for the remainder of the day.
2 Have an adult stay with you until you’re fully alert.
3 Don’t perform any strenuous or hazardous activities and don’t drive a motor vehicle for the rest of the day.
4 Don’t eat a heavy meal immediately. If you’re hungry, eat something light, e.g. liquids and toast.
5 If you experience nausea, lie down for a while or drink a glass of coke.
6 Don’t drink alcohol or take medications for the rest of the day unless you’ve contacted your dentist first.
7 Take any medications as directed.
About The Author:
This article is written by Dan, who is associated with Docklands Dental. Docklands Dental is an award winning dental practice based in the IFSC. They provide pain free practice, with cutting edge technology for patient communication, diagnosis and treatment. They offer specialist services for oral surgery and implant placement.
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