Patients – Intravenous (IV) sedation
The drug used in IV sedation is midazolam which comes from the family of drugs known as benzodiazepines. It produces a state of relaxation. The patient may remember very little of the dental visit as the medication used may causes amnesia (partial or full memory loss) and disturb their sense of time. As a result the patient feels the time they have been in the dental chair has been shortened.
It is important for the patient to have a light meal before the procedure and take their regular medications unless told otherwise by the dentist.
On arrival at the surgery the medical and dental history is reconfirmed with the patient and the consent form signed. An escort must be present with the patient before any sedation is given.
Once ready for treatment, midazolam is put into the patients’ vein using a canula that has been placed either in the back of the hand or half-way up the arm, inside the elbow. The canula is a plastic tube which is left in place until the patient is ready for discharge. There is minimal discomfort during the placement of this canula and if required a cream, placed on the area for 40 minutes, can be used to numb the skin before the canula is put in. Once the patient is relaxed dental treatment can begin.
The patient’s pulse, oxygen saturation levels and blood pressure are monitored before, during and after the procedure using a pulse oximeter (a clip that attaches to the patient’s finger or ear). It is important not to wear any nail varnish as it can interfere with the readings.
The patient will need to bring a responsible escort to accompany them home following their dental treatment otherwise they cannot be treated. Until the following morning it is important that patients do not operate machinery (cars/bicycles), sign any important documents, use the internet for shopping, drink alcohol or take any unprescribed drugs. It is important that patients who have children organise suitable child minding for the rest of the day following the procedure.
Who is suitable for intravenous sedation?
It is very helpful for patients who have dental anxiety, those who are dental phobic and special needs patients as well as those patients who wish to reduce the stress involved in attending for a dental appointment.
Who is not suitable?
It is important that anyone opting for sedation ensures that they give a full and complete medical history and tell their dentist of any drugs (prescriptive or non-prescriptive) they are taking as this can interfere with the action of the sedative medication.
The dentist will decide if the patient is suitable after assessment for sedation but those patients who have a known allergy to the sedation drug or are pregnant are not suitable for treatment.
The following table from The American Society of Anaesthesiology Classification of Physical Status (ASA) is used to assess whether the patient is: a) suitable candidate for IV sedation; and, b) if the patient is to be treated in a practice or hospital setting.
I Normal, healthy patient.
II A patient with a mild systemic disease, e.g., well controlled diabetes mellitius or epilepsy, mild asthma.
III A patient with severe systemic disease limiting activity but not incapacitating, e.g., epilepsy with frequent fitting, uncontrolled high blood pressure, recent heart attack.
IV A patient (usually hospitalised or confined to bed) with incapacitating disease that is a constant threat to life.
Categories I and II can be treated in a general dental practice whilst categories III and IV are treated in a specialist setting.
What are the advantages of IV sedation?
It is fast, reliable and the dose is adjusted to the needs of the patient. It produces a predictable level of sedation. The patient remains awake and can respond to commands throughout the procedure, as with all conscious sedation procedures.
What are the disadvantages?
The patient must bring an escort to accompany them home and have someone stay with them until the next day. While it is a very safe and useful for most patients there are a small number of severely phobic patients who may not benefit from conscious sedation.
All patients receiving conscious sedation for dental treatment require an individual assessment prior to the sedation appointment by a dentist with postgraduate training and any questions can be answered at this appointment.
