Sedation is a way of safely making you unaware of what is happening around you so that your dentist can do a procedure.
Intravenous sedation is a form of sedation where medications are given through a vein by a specialist doctor (usually an anaesthetist) to make you unaware of your surroundings. It is sometimes called Twilight sleep or Conscious Sedation
IV sedation is a more predictable form of sedation. Appropriate amounts of medications are given, in small doses, till a desired state of drowsiness is reached. Oral (non IV sedation) is more “hit and miss” in that you swallow the sedating medications and the time it takes to reach the desired effect is very variable and can be unpredictable.
With IV sedation all your reflexes remain intact. That means you breathe normally and can cough spontaneously. A general anaesthetic (GA) is very much “deeper” and these reflexes are lost. With a GA, the anaesthetist needs to intervene to assist your breathing, whilst with IV sedation this is seldom necessary.
The vast majority of patients describe having a good sleep and waking feeling refreshed after IV sedation. They have no recollection of the dental procedure, or of any injections or indeed any pain or discomfort! Some patients may recall hearing us talking but not being in any way perturbed by this. They also have no recollection of any pain or discomfort.
A very small plastic tube is inserted into your vein, (you will feel a tiny jab) and you are connected to various monitoring devices. Small amounts of a short acting sedative drug are then given through the plastic tube, until you are oblivious to your surroundings. We are very careful when giving this drug to make youare unaware of your surroundings, but still awake enough to respond to requests. As this drug is broken down by your body rapidly, we continue to give small amounts throughout the entire procedure so that you can remain oblivious the entire time. IV sedation is a gentle balance and we can achieve this with the drugs available to us.
A trained Specialist Anaesthetist will be looking after you while you aresedated and anaesthetised. He is aware of what is safe and not safe to do in a dental surgery and won’t cross that line. He will ensure that all the necessary monitoring, resuscitation equipmentis available so the sedation is carried out safely. Some patients with multiple other chronic illnesses may be unsuitable for IV sedation in a dental surgery. This is why it is important that you fill in a health questionnaire. There are risks associated with IV sedation. It is our role to try to minimise the risks. Modern anaesthesia is very safe and arguably IV sedation, done carefully is one of the safest forms of anaesthesia. It is difficult to quantify specific risks for IV sedation as events are so rare, but in general the most common complication (but still very rare complication) of anaesthesia is an allergic reaction to a drug. we have the equipment to manage this. Other risks may be related to any pre-existing diseases you may have. It is also necessary to point out some side effects of IV sedation. These are things that are more likely to happen, and are a consequence of what we have done. The most common side effect is a feeling of wooziness and light headedness afterwards. This settles with time.
Also very occasionally patients can feel nauseated. You may notice some bruising around the IV site; like all bruises this will go away.
Your stomach should be empty of food and fluids prior to starting IV sedation. The reason for this is that if your stomach is full, there is a small chance that you could vomit the contents up and then suck the contents into your lungs. This is potentially a very dangerous situation. It is prevented by ensuring that you have fasted for the time periods above. If you are not adequately fasted, in the interest of safety we may be forced to delay or even cancel your appointment till another time. Remember however that a sip of water to take your medications is OK.
After IV sedation you can expect to feel rested and clearheaded, but in reality your thought processes are not as clear as you perceive them to be. This is exactly the same as being drunk. You think that you are fine but this is not so. The drugs used are very short acting so that by about 12 hours afterwards your body would have broken them down completely, but until then the biggest decision you should make is which channel to watch on TV!