What is IV Sedation?

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). Conscious sedation is sometimes (incorrectly) referred to as twilight sleep or sleep dentistry.

What does it feel like? Will I be asleep?

A lot of dental offices use terms such as sleep dentistry or twilight sleep when talking about IV sedation. This is confusing, because it suggests 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.

First-hand accounts of IV sedation.

Overall it went VERY well… amnesia is very strange! At the dentist office they took my blood pressure, set up the pulse-ox on my finger, and started oxygen. As soon as the IV was started in my arm – I have no further memory of anything! My friend said that during the procedure I would bring my hand up toward my face and draw my knees up but when the assistant told me to put my hand or knees down, I did… When I woke up, the assistant, the dentist and my friend told me to swing my legs around and stand up … which I did very slowly… my friend said it took me about a 10 minutes to get from the dentist chair to the car. The Dentist and my friend were very patient and gentle with encouraging me to open my eyes, stand up and walk… I would have preferred to sleep! I have no memory of the ride home, but felt very relaxed and comfortable.

Is it still necessary to be numbed with local anaesthetic?

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 anaesthetic has taken effect (i. e. until you’re numb) before starting on any procedure.

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.

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. Your blood pressure will be monitored before and during the procedure with a blood pressure measuring machine.

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 anaesthetic on its own!

However, contraindications include pregnancy, known drug allergies, alcohol intoxication, CNS depression. 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 – you don’t want to know. The alternative is oral sedation using Halcion, 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.

The drugs used in IV Sedation produce amnesia for the procedure and is therefore ideal for those with a severe dental phobia.

The drugs used in IV Sedation provide pain blocking actions to your brain that is therefore ideal for patients that have difficulty or unable to get numb.

The gag reflex is hugely diminished – people receiving IV sedation rarely experience difficulty with gagging.

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. If you cannot tolerate this, having inhalation sedation (Nitrous Oxide) before the venipuncture helps, because it relaxes you and produces a tingling feeling in arms and legs which distracts from the venipuncture.

It is possible to experience complications at the site where the needle entered, for example hematoma (a localized swelling filled with blood).

Recovery from IV administered drugs is not complete at the end of dental treatment. You need to be escorted by a responsible adult. You may not drive for the next 24 hours.

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