IV Sedation

Serving Boulder, CO

When a medication is given through an IV, it is referred to as Intravenous Conscious Sedation (aka, "IV sedation"). Conscious sedation Is sometimes (i referred to as "twilight sleep" or "sleep dentistry". During sedation you are not "asleep" but will have a decreased memory of the appointment. That leads to the description that you have been "asleep". Providing medication through an IV is safer and more accurate than taking a pill. We can control your level of comfort and sedation very accurately and reverse the sedation at any time, unlike oral medication.

What does it feel like? Will I be asleep?
A lot of dental offices use terms such as "sleep dentistry" . Many provide pills prior to the procedure either by the patients choice or because the dentist is not credentialed by the state to administer IV sedation or handle potential complications with sedatives. Dr. Barnes is licensed and credentialed in Colorado to administer oral sedation and IV sedation.

You remain conscious during IV sedation. You will also be able to understand and respond to requests, swallow and breathe by yourself. The sedation relaxes you and provides amnesia of the appointment. Pain medication is also used (if necessary) to insure comfort after the appointment is done.

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. If you have a fear of injections, you will not be numbed until the IV sedation has fully kicked In, Dr. Barnes will wait until the local anesthetic has taken effect (i. e. until you're numb) before starting on any procedure.

What are the drugs and what do the drugs do?
Good question!! For light conscious sedation the most commonly used drugs are benzodlazepines. IV administered benzos have 3 main effects: they reduce anxiety/relax you, they make you sleepy, and they produce partial or total amnesia (i.e. make you forget what happened during some or, less frequently, all of the procedure).

By far the most commonly used drug for IV sedation is Midazolam (Versed). Midazolam Is the first choice because of its relatively short duration of action (meaning that It'll be out of your system faster).

Opiods such as Meperidine (Demerol) are strong pain-killers and be used as an add-on if needed.

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, allergy to the medications, 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.

For patients requiring more complex sedation Dr. Barnes works with a trained nurse anesthetist. Barbiturates can be used and have one main advantage over benzos, and that Is that they can be used to provide more time and depth of conscious sedation. We would use Propofol instead of versed, as well as other medications. The advantage of this is the very rapid recovery time, less than 5 mins. The disadvantage Is the drug must be continuously administered, so the drug Is pumped in using an electric infusion pump, the dose rate is set by the anesthetist.

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 in the 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 individuals needs. This is a huge advantage compared to oral sedation, where the effects can be very unreliable.
• The maximum level of sedation which can be reached with IV is deeper than with oral or Inhalation sedation.
• The gag reflex Is hugely diminished - people receiving IV sedation rarely experience difficulty with gagging. However, If minimizing a severe gag reflex is the main objective, a nurse anesthetist might be used to insure a variety of medication choices.
• Can be Ideal for those with a phobia of dental injections.

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 ("laughing gas") 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. This is also true of oral sedation.
• 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.
• Before IV Sedation:
  Light Sedation: It is very important to be well hydrated the day before the procedure however,do not eat or drink anything for 6 hours before you are scheduled for your procedure. This decreases the chance of nausea and vomiting during your procedure and the risks associated should that occur.
  Heavier Sedation: Do not eat or drink anything for 8 hours before you are scheduled for your procedure. This decreases the chance of nausea and vomiting during your procedure and the risks associated should that occur.

After IV Sedation:

1. Have your escort take you home and rest for the remainder of the day.
2. Have an adult stay with you until you're fully alert.
3. Don't perform any strenuous or hazardous activities and don't drive a motor vehicle for the rest of the day.
4. Don't eat a heavy meal Immediately. If you're hungry, eat something light, e. g. liquids and toast.
5. If you experience nausea, lie down for a while or sip some ginger ale.
6. Don't drink alcohol or take medications for the rest of the day unless you've contacted your dentist first.
7. Take medications as directed by your dentist.

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