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HomeOral Sedation and IV Sedation

Oral Sedation and IV Sedation

Oral Sedation and IV Sedation

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Oral Sedation
IV Sedation
What is the difference between IV sedation and general anaesthesia?
How safe is IV Sedation?

Oral Sedation

Oral sedation is a safe, effective and inexpensive way of being able provide necessary dental treatment to anxious patients. the sedative drugs are not designed to make the patient sleep but rather to take the nervousness away and have a calming effect. the patient will feel drowsy and may want to nod off but at the same time will be able to respond to questions and instructions.

Most commonly, oral sedation [usually in the form of anti-anxiety pills also known as “happy pills] is prescribed for relieving anxiety just before and during the dental appointment.

In dentistry most of the drugs prescribed for anxiety belong to the benzodiazepine family you’ve probably heard of some of them by their tradenames e.g. Valium, Halcion, Xanax and Temazepam. In general benzodiazepines act as sedative hypnotics – induce a calming effect including drowsiness [“sedation”]. In higher doses they induce a state resembling physiologic sleep [“hypnosis”].

You will typically not be fast asleep but rather very relaxed and indifferent to what’s happening around you. In fact if necessary you will be able to converse with the dentist or hygienist during the treatment. Quite often the drugs will have an amnesic effect and you may not remember the experience at all.

Because of the drowsiness these drugs create it is vital that a responsible adult is available to collect you after the sedation procedure. Furthermore it is not safe for you to drive the same day, nor appropriate for you to have to make any important decisions that day.

IV Sedation

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.

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.

How safe is IV Sedation?

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:

  1. Please do not eat or drink for 6 hours prior to your appointment time.
  2. You can however drink clear fluids (water, clear juice, black tea or coffee) until 2 hours before your appointment time
  3. 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.
  4. 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.
  5. 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!
  6. 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.

Frequently asked questions

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.

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.

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.

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.

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!