Intravenous Conscious Sedation
IV Sedation or Intravenous Conscious Sedation is when a drug, usually of the anti-anxiety variety, is administered into the blood system during dental treatment.
What does it feel like? Will I be asleep?
Many dental practitioners describe IV sedations as “sleep dentistry” or “twilight sleep” however this may cause confusion as it gives the impression that IV sedation means that you will be put to sleep. These terms are more descriptive of deep sedation. Deep sedation isn’t commonly used, and is classified as general anaesthesia.
In reality you remain conscious during conscious IV sedation. You will also be able to understand and respond to requests from your dentist.
However you might have little or no recollection about the procedure for two reasons:
- IV sedation induces a state of deep relaxation and a feeling of not being bothered by what’s going on.
- The drugs used for IV sedation produce either partial or full memory loss (amnesia) for the period of time when the drug first kicks in until it wears off. The effect of this is that time seems go by quickly and you have very little recollection of what has just occurred. A lot of patients remember none of the proceedings which suggests that during the procedure there was a period of sleeping.
Is it still necessary to be numbed with local anaesthetic? Will my dentist numb my gums before or after I’m sedated?
The drugs which are usually used for IV sedation are not painkillers, 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 given?
“Intravenous” means that the drug is put into a vein. An ultra thin needle is put into a vein near to the surface of the skin either in the arm or the back of your hand. The anti-anxiety drug used is Midazolam, chosen because it is a short acting benzodiazepine.
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 an audible early warning sign if you’re getting too low on oxygen, although if your dentist and the nurses are paying attention they should see it way before the machine does. Blood pressure before and after the procedure should be checked 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:
- known allergy to benzodiazepines
- alcohol intoxication
- CNS depression
- some instances of glaucoma
Heart disease is generally not a contraindication
Your individual dentist will discuss with you the specific instructions relevant to your case, including any does and don’ts, after a thorough pre-assessment.