IV Sedation

Nitrous Oxide

Nitrous oxide has been the primary means of sedation in dentistry for many years. Nitrous oxide is safe; the patient receives 50-70 percent oxygen with no less than 30 percent nitrous oxide. It is a sweet smelling, non-irritating, colorless gas which is inhaled. The patient is able to breathe on his or her own and remain in control of all bodily functions.

The patient may experience mild amnesia and may fall asleep not remembering all of what happened during their appointment.

There are many advantages to using nitrous oxide

• The depth of sedation can be altered at any time to increase or decrease sedation.
• There is no after effect such as a "hangover"
• Inhalation sedation is safe with no side effects on your heart or lungs
• Inhalation sedation is very effective in minimizing gagging
• It works rapidly reaching the brain within 20 seconds. In as few as two to three minutes, it's relaxation and pain-killing properties develop.

Reasons Not To Use Nitrous Oxide

Though there are no major contraindications to using nitrous oxide, you may not want to use it if you have emphysema, chest problems, multiple sclerosis, a cold, or other difficulties with breathing.

You may want to ask your dentist for a five-minute trial to see how you feel with this type of sedation method before proceeding.

back to top

IV (Intravenous) Sedation Oceanside CA

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 a "twilight sleep" or "sleep dentistry". These terms are more descriptive of deep sedation. Deep sedation isn't commonly used (in the UK at least), and is more closely related to general anesthesia (even though sedation occurs on a continuum). This page answers the most common question regarding conscious IV sedation. Please be aware that this page contains some explicit description.

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 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 request from 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.

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 or your hand. This needle is wrapped up with a soft plastic tube. The needle makes the entry into the vein, then is slid out leaving the soft plastic tube in place. The drugs are put in through that tube (which is correctly referred to as an "indwelling catheter"), but more commonly known by the tradename of venflon). The tube system in place throughout the procedure.

The venflon to the right is a pinkie, which is one size bigger than blue on that's usually used for IV sedation in dentistry.

Throughout the procedure, your pulse and oxygen levels are measured using a "pulse oximeter". This gadget clips onto a finger or an earlobe and measures pulse and oxygen saturation. It gives a useful early warning sign if you're getting dangerously low on oxygen, although if your dentist and the nurses are paying attention they should see it before the machine does =). The warning signs are unresponsiveness and slow breathing. Blood pressure before and after the procedure should be checked with a blood pressure measuring machine (a tongue-twister called "sphygmomanometer", which for obvious reasons is referred to as "sphg").

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 US 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 that oral or inhalation sedation.
• Benzos produce amnesia for the procedure.
• 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, inhalation sedation is usually tried first. Only if that fails to diminish the gag reflex should IV sedation be used for this purpose.
• Can be ideal for those with a phobia of dental injections.
• Unlike General Anesthesia or Deep Sedation, conscious IV sedation doesn't really introduce any compromises per se in terms of carrying out the actual procedures, because people are conscious and they can cooperate with instructions, and there is no airway tube involved.

Are there any disadvantages?

• A needle has to be put in the arm of hand ("venipunture"). 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).

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 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 drink a glass of coke.
6. Don't drink alcohol or take medications for the rest of the day unless you've contacted your dentist first.
7. Take medication as directed by your dentist.
8. If you have any unusual problems, call your dentist.

back to top

Indications

The Primary indications for the use of inhalation sedation are the same as those for other sedative techniques: the management of fear and anxiety, the medically compromised patient, and the management of gagging. Over the above these usual indications, N2O-O2 is readily controllable; this permits its use for aspects of dental care in which the use of moderate sedation might not usually be considered.

Many procedures that are generally considered non- threatening or even innocuous might, however, prove to be extremely traumatic to some patients. Many of these procedures lend themselves quite readily to the use of N2 O-O2.

Anxiety

The major indication for the use of N2 O-O2 inhalation sedation in dentistry is, of course, the management of fear and anxiety related to the dental experience. As discussed in the preceding section on the advantages of inhalation sedation, N2 O-O2 represents the most nearly ideal sedation technique, were it not for the fact that some persons are not comfortable with the effects of N2 O-O2, that some others will not achieve clinically adequate sedation at permissible percentages, and that still others are unable to breath through their noses, inhalation sedation would be the only technique of sedation required for the management of dental anxieties.

Medically Compromised Patients

In recent years, the use of N2 O-O2 has become increasing important in the management of medically compromised patients.

Some examples are:

Gagging

Gagging is a potential problem during many dental procedures, especially in the maxillary palatal and the posterior mandibular lingual region. Although there is no absolute solution to this problem (other than general anesthesia), inhalation sedation with N2 O-O2 has proven to be highly effective in eliminating or at least minimizing sever gagging. Patients are titrated with N2 O-O2 to their sedation level, at which point impression, radiographs, or other procedures may be completed. The use of N2 O-O2 to diminish the gag reflex may require placing the patient in an upright position for some or all the procedure. Although this position is not usually recommended during sedation (supine is preferred), some procedures, such as impressions in the maxilla, may require modification of position for increase patient safety. Where other sedation techniques (especially IV sedation) are also effective in decreasing gagging, only N2O is practical to use for extremely short procedures, such as radiographs or impressions.

Contraindications

There are relatively few absolute contraindications to the administration of N2O-O2 inhalation sedation as long as the percentage of O2 administered with the N2O is greater than 20% (atmospheric concentration). However, there are several relative contraindications to this technique. A relative contraindication implies that there is an increase potential for an adverse reaction to develop in certain patient. Although the technique in question may be used, if there exists another technique without this contraindication that would prove to be equally successful, it should be used in place of the contraindicated technique. The following are relative contraindications to N2O-O2 inhalation sedation.

Some examples are:

• Patients With a Compulsive Personality
• Claustrophobic Patients
• Children With Sever Behavior Problems
• Upper Respiratory Tract Infection
• Pregnancy After Second Trimester.

back to top