Are there any contraindications for 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 anaesthetic
on its own!
However, contraindications include pregnancy, known allergy to benzos,
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.
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 higly reliable.
* The maximum level of sedation which can be reached with IV is deeper than
with 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 Anaesthesia 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 for IV sedation?
* 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).
* While IV sedation is desired precisely because of the amnesia effect (i. e.
forgetting what happened while under the influence of the drug/s), there can be
a downside to this: if you can't remember that the procedure wasn't
uncomfortable or threatening, you can't unlearn your fears. However, it depends
on the precise nature of your phobia and the underlying causes to which extent
this may be a problem. Some people would voice a concern that some patients
can't be "weaned off" IV sedation, as dental anxiety tends to returns
to baseline levels. As a result, people who rely on IV sedation may be less
likely to seek regular dental care. Other people would argue that this is not a
concern if IV sedation is readily available to people.
* Recovery from IV administered drugs is not complete at the end of dental
treatment. You need to be escorted by a responsible adult.
* 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.