IV (Intravenous) Sedation for Nervous Dental Patients in Southampton

A lot of dental clinics and practices refer to IV sedation as “sleep dentistry” but this is not entirely accurate as it suggests that the patient is actually being put to sleep. Deep sedation would better describe sleeping during surgery but this form is seldom used in dentistry, particularly in the UK.

So for IV sedation you remain conscious and able to understand and respond to requests from your dentist.
However, you may not remember much about the procedure because of two things:

1.IV sedation induces a state of deep relaxation and the feeling that you are not really bothered by events surrounding you.

2. the drugs used for IV sedation produce either partial or full memory loss for the period of time when the drug first affects you until it wears off. Patients report that time passes quickly and in fact that they felt like they had been asleep.

The IV sedation drugs are not painkillers although some pain-killing drugs are occasionally added at the initial sedation. So whilst you will feel deeply relaxed, you will still need to be numbed.

Will this be done before or after I’m sedated?

However, if you fear injections, you will not be numbed until the IV sedation has taken full effect. Experience suggests that the IV sedation process is so effective that you will likely not care about the needle in any case. As you would expect, the dentist will not begin any procedure until it’s is certain that the numbing effect of the painkiller is fully established.

“You check the local anaesthetic has worked by asking the patient. Just coz they’re sedated doesn’t mean they can’t answer you… in fact they better be able to answer or they ain’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 Gordon Laurie, BDS – yet again!)

The drugs used for IV sedation are administered intravenously using a very fine needle around which a thin plastic tube is wrapped. The needle punctures the vein, typically on the back of the hand and is then removed backwards through the plastic tube. The tube remains in place during the process and it is through this that the drugs make their way into your body.

To ensure patient safety your pulse and oxygen levels are measured throughout the procedure using a “pulse oximeter”. This device clips onto a finger or an earlobe and measures pulse rate and levels of oxygen in the blood. This is the safety “catch net” but an experienced dental team will be able to spot any issues with vital signs before the machine steps in. Blood pressure before and after the procedure is checked with a “sphygmomanometer” to ensure that it is within normal range.

A strong topical anaesthetic or numbing cream can be used to make the site where the needle goes completely numb.

The most commonly used drugs for IV sedation are benzodiazepines. These are anti-anxiety, sedative drugs which have 3 main effects:

• a) they reduce anxiety and relax you,
• b) they make you sleepy,
• c) they produce partial or complete amnesia so that you forget most if not all of the procedure.

The level of amnesia experienced varies depending on the drug used – full amnesia is more common with midazolam compared to diazepam. The drug is put into the vein at the rate of 1mg per minute for Diazepam or 1 mg every 2 minutes (followed by an extra 2 minutes to evaluate the effect) for Midazolam.

The process with Midazolam is slightly longer because it is stronger in terms of the dose needed to achieve sedation. All individual differ hence the quantity of drug needed must be monitored carefully - once the desired level of sedation is achieved, the flow of drug is stopped. The Venflon (thin plastic tube in the vein) is left in place during the procedure so that the sedation can either be topped up or so that the reversal agent for benzodiazepine (Flumazenil) can be used if there is an unlikely problem with the patient.

IV sedation is extremely safe when carried out under the supervision of a trained dental team.

Statistically speaking, it is even safer than local anaesthetic on its own. However, there are some contraindications that include:

• pregnancy
• allergy to benzodiazepines
• alcohol intoxication
• CNS depression, and
• some instances of glaucoma.

Its use is also cautioned for cases of psychosis, impaired lung, kidney or liver function, advanced age and sleep apnoea, however heart disease is generally not a contraindication.

Benzodiazepines tolerance cane increase if you have been taking them for long periods so please let your dentist know.

• IV sedation is more effective that oral sedation (using temazepam) so it is the preferred option if you really don’t wish to know what happened.
• It is rapid acting and the level of sedation can be tailored to the individual’s needs. IV sedation is both highly effective and reliable.
• The level of sedation which can be reached with IV is deeper than with oral or inhalation sedation.
• Benzodiazepines used for the procedure produce short-term amnesia.
• The gag reflex is significantly diminished using IV sedation.
• Unlike General Anaesthesia or Deep Sedation, conscious IV sedation doesn’t introduce any compromises for dental procedures. This is because the patient is still conscious and can cooperate with instructions. Additionally there is no uncomfortable airway tube involved.

• In rare cases it is possible to experience small complications at the site where the IV needle entered the vein, for example small localised swellings filled with blood – these are typically short-lived.
• The recovery from IV drugs is not complete at the end of dental treatment and you need to be escorted by a responsible adult for a short period of time until the effects wear off.
• If you are afraid of not being in control, then it may be more difficult to achieve an effective sedation – as such you should be receptive to the idea of sedation.
• Cost – IV sedation is more expensive than oral sedation but it has clear benefits

A light meal is allowable before the procedure.

• Ensure you are escorted home and the rest for the remainder of the day.
• Have an adult look after you until the effects have worn off completely.
• Don’t drive or perform strenuous activity on the same day of the procedure
• If you are hungry directly afterwards, eat a light meal, not something heavy.
• If you experience nausea, lie down and take a sweet drink e.g. Coca Cola.
• Don’t drink alcohol for the rest of the day following the procedure
• Take medications only after discussion with and as directed by your dentist.
• If you experience any post procedure problems, call your dentist.