IV Sedation is a way of safely making you unaware of what is happening around you so that your dentist can do a procedure.
Intravenous sedation is a form of sedation where medications are given through a vein by a specialist doctor (usually an anaesthetist) to make you unaware of your surroundings. It is sometimes called Twilight sleep or Conscious Sedation.
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What is the difference between IV and other forms of sedation?
IV sedation is a more predictable form of sedation. Appropriate amounts of medications are given, in small doses, untill a desired state of drowsiness is reached. Oral (non IV sedation) is more “hit and miss” in that you swallow the sedating medications and the time it takes to reach the desired effect is very variable and can be unpredictable.
What is the difference between IV sedation and general anaesthesia?
With IV sedation all your reflexes remain intact. That means you breathe normally and can cough spontaneously. A general anaesthetic (GA) is very much “deeper” and these reflexes are lost. With a GA, the anaesthetist needs to intervene to assist your breathing, whilst with IV sedation this is seldom necessary.
What can I expect to feel with IV sedation?
The vast majority of patients describe having a good sleep and waking feeling refreshed after IV sedation. They have no recollection of the dental procedure, or of any injections or indeed any pain or discomfort! Some patients may recall hearing us talking but not being in any way perturbed by this. They also have no recollection of any pain or discomfort.
How is IV sedation done?
A very small plastic tube is inserted into your vein, (you will feel a tiny jab) and you are connected to various monitoring devices. Small amounts of a short acting sedative drug are then given through the plastic tube, until you are oblivious to your surroundings. I am very careful when giving this drug as I aim to make you unaware of your surroundings, but still awake enough to respond to requests. As this drug is broken down by your body rapidly, I continue to give small amounts throughout the entire procedure so that you can remain oblivious the entire time. IV sedation is a gentle balance and I can achieve this with the drugs available to me.
How safe is all of this?
I am a trained Specialist Anaesthetist and looking after sedated and anaesthetised patients is my full-time job. I am aware of what is safe and not safe to do in a dental surgery and for both of our sakes, I won’t cross that line. I ensure that I have all the necessary monitoring, resuscitation and treatment equipment so that I can carry out the sedation safely. Some patients with multiple other chronic illnesses may be unsuitable for IV sedation in a dental surgery. This is why it is important that you fill in the attached health questionnaire and fax it or post it back to me. If you have lots of illnesses, it may be necessary to see you before the procedure or to at least talk on the telephone to work out a safe plan of management.
There are risks associated with IV sedation. It is my role to try to minimise the risks. Modern anaesthesia is very safe and arguably IV sedation, done carefully is one of the safest forms of anaesthesia. It is difficult to quantify specific risks for IV sedation as events are so rare, but in general the most common complication (but still very rare complication) of anaesthesia is an allergic reaction to a drug. I have the equipment to manage this. Other risks may be related to any pre-existing diseases you may have.
It is also necessary to point out some side effects of IV sedation. These are things that are more likely to happen, and are a consequence of what we have done. The most common side effect is a feeling of wooziness and light headedness afterwards. This settles with time. Also very occasionally patients can feel nauseated. You may notice some bruising around the IV site; like all bruises this will go away.
There are some important things to remember on the day of surgery:-
- Please do not eat or drink for 6 hours prior to your appointment time.
- You can however drink clear fluids (water, clear juice, black tea or coffee) until 2 hours before your appointment time
- Take your regular medications with a sip of water in the morning. The exception to this is if you are a diabetic and on antidiabetic medications. If you are a diabetic it is important that we talk or meet before the appointment to manage this further.
- Please wear comfortable, loose fitting clothes on the day of surgery. It is necessary to get easy access to you arms so sleeveless garments or garments with sleeves that can be loosely rolled up are suitable.
- Please remember to go to the toilet and empty your bladder before the start of the procedure. A full bladder can make you very restless during IV sedation and can contribute to a raised blood pressure!
- After IV sedation your judgment will be impaired for a period of about 12 hours. It is essential therefore that you have a responsible person accompany you home and stay with you. It is also important that you don’t do any tasks that require skill during this period. This would include not driving, not making any important decisions, not cooking, not using stoves or microwaves etc.
Why is it necessary to fast for so long before IV sedation?
Your stomach should be empty of food and fluids prior to starting IV sedation. The reason for this is that if your stomach is full, there is a small chance that you could vomit the contents up and then suck the contents into your lungs. This is potentially a very dangerous situation. It is prevented by ensuring that you have fasted for the time periods above. If you are not adequately fasted, in the interest of safety I may be forced to delay or even cancel your appointment till another time. Remember however that a sip of water to take your medications is OK.
Why do I need a responsible person to stay with me after the procedure?
After IV sedation you can expect to feel rested and clearheaded, but in reality your thought processes are not as clear as you perceive them to be. This is exactly the same as being drunk. You think that you are fine but this is not so. The drugs used are very short acting so that by about 12 hours afterwards your body would have broken them down completely, but until then the biggest decision you should make is which channel to watch on TV!