Sedation

Intravenous Sedation
Intravenous Sedation is the strongest form of sedation available within a dental practice. It is a modern, safe technique which takes the anxiety out of dentistry and makes treatment a more pleasant experience. It has been used for many years in dentistry, and in the wider field of medicine for procedures such as endoscopy. As for Oral Sedation, Midazolam, which is a Benzodiazepine is used.

IV Technique
The technique involves placing a cannula into an arm vein. Through this cannula the Midazolam can then be administered painlessly. Because the sedative is administered directly into your blood stream we do not have the difficulties with adjusting the dose that exist when medicines are taken orally. Thus we can titrate (adjust) the dose depending on an individual patient’s response and comfort. We can also slowly administer the sedative to keep a patient comfortable over a long time period for extended appointments.
 
Midazolam has a number of effects when administer intravenously. It has a very strong anti-anxiety effect; it relaxes muscles, makes the patient sleepy and also produces amnesia (forgetfulness). Because it is fast acting, within a few minutes of administering the sedative the patient becomes very relaxed and drowsy, and treatment can be carried out in comfort. Local anaesthetic injections will also be used. As the anaesthetic is normally given immediately following the sedation it is unlikely that you will have any memory of them.
 
Midazolam will not put you to sleep, though it does relax some patients sufficiently that they will “fall” asleep on their own. However, it may seem as if you have been asleep for most of the treatment because of the effect it has in producing amnesia. The nice part about the patient being awake is that we can talk to you and ensure your comfort- yet afterwards you will have little if any memory of the procedure.

Some people are aware of talking. You may also have a heightened sense of touch and some people experience hallucinations which may be of a sexual nature. There will be two people present in the room with you at all times to ensure your safety. Midazolam wears off quickly after your appointment; as a result, there are very few after-effects apart from a feeling of drowsiness. Most people will feel better the following day; however for some the effects of the sedation will still be present for 1-2 days afterwards. It is important that you do not drive or operate any machinery for at least 24 hours after your appointment or until all effects are gone, whichever is the longer period.

Midazolam has been used for many years in the medical and dental field and has a good record of safety. Midazolam suppresses your respiration and your cardiovascular system thus your breathing will slow down and blood pressure will lower. The most common risk/side effect from sedation is over-sedation which can suppress your breathing excessively and/or cause confusion. We monitor closely for this and should it occur, we have a reversal agent (Annexate) available which can be immediately administered and will wake you immediately.

To avoid over sedation we administer Midazolam very slowly. Your heart rate and oxygen saturation levels are monitored throughout your appointment and your blood pressure is also recorded at intervals.

Medical Conditions
IV sedation is suitable for most patients. However, there are some medical conditions which mean that we either can not use IV sedation or need to adapt the sedation to suit the patient. There are also some medications which may interact with Midazolam. It is important that we have a full and accurate medical history and a complete list of all medications you are taking.
Elderly people are especially sensitive to the effects of Midazolam. This may increase the chance of side effects during the use of this medicine and the time to complete recovery after Midazolam is given may be slower in the elderly than in younger adults.
 
On completion of treatment the patient rests for a short period before being escorted home. While many feel quite alert at this stage, it should be remembered that the sedative drugs are not completely eliminated from the body for hours – hence the need for an escort.
 
In order to be able to provide IV sedation the dentist is required to have Level 6 Emcare training the New Zealand Resuscitation Council and the assistant is required to have Level 4. Level 6 is the same level as a senior nurse in an Emergency Department or a Paramedic is required to have. We also carry oxygen and other emergency resuscitation drugs on site.