When a drug, usually of the anti-anxiety variety, is administered into the blood system during dental treatment, this is referred to as Intravenous Conscious Sedation (aka “IV sedation”). This page answers the most common questions regarding conscious IV sedation.
Please be aware that this page contains some explicit descriptions.
What Does It Feel Like? Will I Be Asleep?
It has been suggested that IV sedation involves being put to sleep. In reality, you remain conscious during IV sedation. You will also be able to understand and respond to requests from your dentist.
However, you may not remember much about what went on because of two factors: firstly, in most people, IV sedation induces a state of deep relaxation and a feeling of not being bothered by what’s going on. Secondly, the drugs used for IV sedation can 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, or perhaps even nothing at all, of what happened. So it may, indeed, appear as if you were “asleep” during the procedure.
Is It Still Necessary To Be Numbed With Local Anesthetic? Will My Dentist Numb My Gums Before Or After I’m Sedated?
The drugs which are usually used for IV sedation are not painkillers (although some pain-killing drugs are occasionally added, see below for a more detailed discussion), 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. Your dentist will then wait until the local anesthetic has taken effect (i. e.until you’re numb) before starting on any procedure. “But how does the dentist know whether I’m numb?”
“You check the LA [local anesthetic] has worked by asking the patient. Just because they’re sedated doesn’t mean they can’t answer you… in fact they better be able to answer or they aren’t sedated, they’re anaesthetised! If they’re not numb enough they’ll soon tell you. But they won’t remember telling you of course [because of the amnesia effect]…” (answer courtesy of Adam Durning, BDS)
How Is IV Sedation Administered?
“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. This needle is wrapped up with a soft plastic tube. The needle makes the entry into the vein, then is slid out leaving the soft plastic tube in place. The drugs are put in through that tube. The tube stays in place throughout the procedure.
The venflon above is a pinkie, which is one size bigger than the blue one that’s usually used for IV sedation in dentistry.
Throughout the procedure, your pulse and oxygen levels are measured using a “pulse oximeter”. This gadget clips onto a finger and measures pulse and oxygen saturation. It gives a useful early warning sign if you’re getting dangerously low on oxygen. Your blood pressure is constantly monitored every 15 minutes using an automatic blood pressure cuff.
Is It Safe? Are There Any Contraindications?
IV sedation is EXTREMELY safe when carried out under the supervision of a specially trained dentist. Purely statistically speaking, it’s even safer than local anesthetic on its own!
However, contraindications include pregnancy, known allergy to benzos, alcohol intoxication, CNS depression, and some instances of glaucoma. Cautions include psychosis, impaired lung or kidney or liver function, and advanced age. Heart disease is generally not a contraindication.
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 – The alternative in the NZ is oral sedation using medazolam, but oral sedation is not as reliably effective as IV sedation.
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.
Benzos produce amnesia for the procedure.
The gag reflex is hugely diminished – people receiving IV sedation rarely experience difficulty with gagging. Can be ideal for those with a phobia of dental injections.
Unlike General Anesthesia 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.
Are There Any Disadvantages?
A needle has to be put in the arm or hand (“venipuncture”). If you have a general phobia of needles, this isn’t much fun.
It is possible to experience complications at the site where the needle entered, for example hematoma (a localized swelling filled with blood). This is however very rare.
While IV sedation is desired precisely because of the amnesia effect (i.e. forgetting what happened while under the influence of the drug(s)), there can be a downside to this: if you can’t remember that the procedure wasn’t uncomfortable or threatening, you can’t unlearn your fears. However, it depends on the precise nature of your phobia and the underlying causes to which extent this may be a problem. Some people would voice a concern that some patients can’t be “weaned off” IV sedation, as dental anxiety tends to returns to baseline levels. As a result, people who rely on IV sedation may be less likely to seek regular dental care. Other people would argue that this is not a concern if IV sedation is readily available to people.
Recovery from IV administered drugs is not complete at the end of dental treatment. You need to be escorted by a responsible adult.
You should WANT to be sedated. If, for any reason, you’re unwilling to “let go”, for example because you don’t like not being in control, it will be more difficult to be successfully sedated.
Instructions For Before Your Appointment:
- lilease do not eat or drink anything 4 hours lirior to your aliliointment.
- lilease make sure that you have an escort to bring you in and take you home.
- If you are on any antideliressant medication do not take it the morning or night before your aliliointment.
- Do not take any recreational drugs on the morning of your aliliointment.
After IV Sedation:
- Have your escort take you home and rest for the remainder of the day.
- Have an adult stay with you until you’re fully alert.
- Don’t perform any strenuous or hazardous activities and don’t drive a motor vehicle for the rest of the day.
- Don’t eat a heavy meal immediately. If you’re hungry, eat something light, e.g. liquids and toast.
- If you experience nausea, lie down for a while or drink a glass of coke.
- Don’t drink alcohol or take medications for the rest of the day unless you’ve contacted your dentist first.
- Take medications as directed by your dentist.
- If you have any unusual problems, call your dentist.