intravenous sedation

IV sedation in dentistry, also known as intravenous sedation, is a technique used to help patients feel calm, relaxed and at ease during dental procedures. It involves administering sedative drugs directly into the bloodstream through a vein, typically in the arm or hand. This method of sedation allows the dentist or anaesthetist to precisely control the level of sedation, making it possible to adjust the dosage throughout the procedure.

WHO NEEDS INTRAVENOUS SEDATION?

IV sedation in dentistry is suitable for a variety of patients, particularly those who experience anxiety or have specific medical or psychological needs. Here are some of the groups of patients who might be suitable candidates for IV sedation:

  • Patients with dental anxiety or phobia

  • Patients requiring lengthy or complex procedures

  • Patients with a strong gag reflex

  • Patients who experience difficulty with anaesthesia

  • Patients with a low pain threshold

  • Patients who have had a previous traumatic dental experience

CONSIDERATIONS ABOUT SEDATION

Before administering IV sedation, a thorough medical assessment is conducted to ensure the patient is a suitable candidate. The patient's medical history, current medications, and overall health are evaluated. IV sedation is not recommended for everyone, such as patients with certain health conditions or those who are pregnant.

IV sedation provides a safe and effective way for a wide range of patients to receive dental care comfortably, but it must be administered under professional supervision with careful consideration of the patient's individual needs.

before sedation

Assess - the clinician will review your medical history to determine the most appropriate sedation method and dosage.

Fasting - avoid eating and drinking usually 6 to 8 hours before the procedure. This is important to prevent nausea and reduce the risk of complications.

Consent - the clinician will discuss the sedation process, risks and benefits. You will need to sign a written consent form acknowledging you understand and agree to the procedure.

Transportation - since sedation can impair your ability to drive, you will need to arrange a chaperone to drive you to and from your appointment.

during sedation

Administration - the sedative (usually midazolam) will be delivered through a vein in your arm or hand.

Onset - the sedation will start to take effect, usually within a few minutes. You will begin to feel relaxed and drowsy, and in some cases experience a warm sensation.

Monitoring - throughout the procedure, your vital signs (heart rate, blood pressure, oxygen levels) will be closely monitored. The clinician will ensure the level of sedation is appropriate.

Anaesthesia - even with sedation, local anaesthesia is used to numb the specific area being treated, ensuring you do not feel pain during the procedure.

after sedation

Recovery - you will be closely monitored until the effects of sedation begin to wear off. You may feel groggy, disoriented and nauseous.

Post-sedation care - you will be given instructions on how to care for yourself after the procedure. This may include taking pain relief, avoiding certain foods and activities.

Transportation - since you will be still under the effects of sedation, you should have someone drive you home and stay with you until you are fully recovered.

After effects - you may experience mild side effects such as drowsiness, a headache, or dry mouth. These usually subside within a few hours. You may not remember much of the procedure.

  • Yes, IV sedation is generally considered safe when administered by a qualified and experienced dentist or anaesthetist. However, like any medical procedure, it carries some risks. The safety of IV sedation depends on several factors, including the patient's health, the expertise of the medical team, and the setting in which the sedation is administered.

  • Allergic Reactions:

    There is a small risk of an allergic reaction to the sedative drugs. This is why a detailed medical history is essential to identify any known allergies.

    Respiratory Issues:

    In rare cases, IV sedation can depress breathing. However, because patients are closely monitored, any breathing issues can be quickly addressed.

    Blood Pressure and Heart Rate Changes:

    IV sedation can cause fluctuations in blood pressure or heart rate, which is why continuous monitoring is essential.

    Over-Sedation:

    While rare, there is a risk of administering too much sedative, leading to deeper sedation than intended. This is another reason why skilled administration and monitoring are crucial.

    Suitability:

    Not all patients are suitable candidates for IV sedation. For example, patients with certain medical conditions (such as severe respiratory issues, obesity, or sleep apnea) may face higher risks. A thorough pre-assessment helps to mitigate these risks.

  • The experience of IV sedation can vary slightly from person to person, but here’s a general overview of what it typically feels like:

    Quick Onset of Relaxation: Since the medication is delivered directly into your vein, you will begin to feel its effects rapidly, usually within a few minutes. You may experience a warm or lightheaded sensation as relaxation sets in.

    Drowsiness and Calmness: IV sedation often induces a deep sense of calm and drowsiness. You may feel very relaxed and unconcerned about the procedure taking place. Anxiety and nervousness typically diminish significantly.

    Altered Awareness: Depending on the level of sedation, your awareness of your surroundings may be mildly to significantly reduced. In moderate to deep sedation, you may drift in and out of sleep but can usually be easily awakened if necessary.

    Minimal Memory of the Procedure: One common effect of certain sedatives used in IV sedation is amnesia, meaning you may have little to no memory of the procedure afterward. This can be beneficial for individuals who are anxious about medical or dental treatments.

    Reduced Sensation of Pain and Discomfort: While IV sedation itself is primarily for relaxation and anxiety reduction, it is often used in conjunction with local anesthesia to control pain. The combination makes the procedure more comfortable and tolerable.

    Possible Physical Sensations: Some people report feeling a slight heaviness in their limbs or a tingling sensation as the medication takes effect. These sensations are generally mild and temporary.

  • Midazolam: Often used for its calming and amnesic effects, helping you forget the procedure.

    Propofol: Known for its quick onset and recovery time, providing deep sedation.

    Fentanyl: Sometimes combined with other sedatives for pain management.