Frequently Asked Questions
WHY CONSCIOUS SEDATION?
Conscious sedation using intravenous midazolam is a great way of reducing anxiety and discomfort for dental treatments. It is a very effective viable alternative to general anaesthesia for many surgical procedures e.g. dental procedures, plastic and reconstructive surgery, dermatology, endoscopies, bronchoscopies, and liver and renal biopsies. There is a significantly lower incidence of side effects with intravenous sedation (including low incidence of nausea and vomiting, headaches, sore throats, muscle aches, and pain) and the costs for conscious sedation are much lower compared to general anaesthesia.
WHAT IS CONSCIOUS SEDATION?
The aim of sedation is to make you comfortable, totally relaxed and safe during the dental implant treatment. Administration of the sedatives and analgesia results in you becoming drowsy and sleepy, pain free, and amnesic such that you will have little recollection of the procedure. At all stages of the procedure it will be possible to converse with you and for you to follow simple instructions, you will also be able to tell us how you are feeling. However, you will have little or no recollection of events.
ARE THERE DIFFERENT LEVELS OF SEDATION?
• Minimal Sedation (or Anxiolysis): This is often referred to as changing the mood of the patient whereby the patient is calmed, responsive to verbal commands, and unconcerned about the procedure. This can be achieved using oral tablets of diazepam or similar type of medicine.
• Moderate Sedation or Conscious Sedation: This is where the patient is more deeply sedated, becomes drowsy and sleepy (and may even sleep intermittently), is always responsive to verbal commands, and calm.
• Deep Sedation: At this level of sedation patients may become unconscious. This level is not allowed in the UK for sedation outside the hospital operating room.
HOW DOES SEDATION DIFFER FROM GENERAL ANAESTHESIA?
The main differences between conscious sedation and general anaesthesia is the level of consciousness, safety, side effects, and cost.
• Cost: the fact that the recovery period of sedation is much quicker than with general anaesthetic, combined with the fact that sedation does not require hospital settings, means that the cost of sedation is far lower than that for general anaesthesia. General anaesthesia can only be performed inside a hospital in an operating theatre.
• Level of consciousness: with conscious sedation the patient is drowsy, comfortable, sleepy and relaxed, but remains conscious. Patients can be roused by verbal communication if necessary. With general anaesthesia the patient is completely unresponsive and cannot be roused by verbal communication.
• Safety: with conscious sedation the required dose of drug is low and the patient is still in control of major reflex functions such as breathing. With general anaesthesia the higher doses of drugs renders the patient unconscious who then loses these reflexes which are then maintained artificially.
• Side effects: due to the lower dose of sedative the frequency of side effects are minimal when compared to general anaesthesia where the side effect profile is much more substantial.
IS CONSCIOUS SEDATION AN OPTION FOR ALL PATIENTS?
The suitability of conscious sedation is determined by the patients’ anxiety level and the type of dental implant treatment planned. Indications for IV sedation are:
• very anxious patients – sedation calms the patient and overcomes their anxiety.
• patients who have had a previous traumatic experience – sedation makes it possible to deal with post-traumatic stress of the patient relating to dental procedures.
• uncomfortable procedures – sedation relaxes, dissociates and helps comfort the patient.
• more complex and prolonged procedures – sedation ensures the patient can remain still yet comfortable for long periods of time.
Conscious sedation should thus always be evaluated with respect to other available options including local anaesthesia and/or regional anesthesia, local anaesthesia with behavioural management techniques, general anaesthesia, and of course conscious sedation itself. Patients should always be involved in decision making after an explanation of the options available.
WHAT CAN I EAT OR DRINK BEFORE SEDATION?
The general guidelines are as follows, see that you follow these guidelines otherwise your operation may have to be cancelled:
• no solid food or liquid for 2 hours prior to the procedure.
• diabetic patients will get special instructions as far as food intake is concerned.
You will receive pre and post-operative instructions explaining what you can and can’t do.
Do i need an injection for IV sedation
Yes you do need a small injection in either the back of your hand or in the crease of your elbow. A cannula will be placed there whilst you have the procedure.
WILL I BE UNCOMFORTABLE AND FEEL ANY PAIN WHILE UNDER SEDATION?
Even though you are not completely asleep, you will be drowsy, relaxed and pain free during the procedure. The sedative drugs combined with analgesics and local anaesthesia ensures that you will have no pain.
HOW LONG DOES IT TAKE TO RECOVER AFTER THE OPERATION AND HOW SOON CAN I GO HOME?
It takes a minimum of 1 hour to recover from intravenous sedation with midazolam. The sedation practitioner will carefully monitor you to ensure that you are fit for discharge after 1 hour. Thereafter you may remain drowsy for a few hours and you will be given specific written and verbal instructions on what to do.
ARE THERE ANY SIDE EFFECTS OF SEDATION?
As with any medication, the use of sedative anaesthetic agents can result in side effects. However, the incidence of side effects with sedation are very rare and include unintended loss of consciousness, drowsiness, dizziness, shivering (4%), headaches (4%), and post sedation nausea & vomiting (0.7%).
HOW SHOULD I SPEND MY TIME AT HOME RECOVERING AFTER THE PROCEDURE?
Elimination of the sedative agents from your body can take up to 24 hours. It is important during this time to rest and recover from the procedure. Therefore, however well you may feel, within that time you should NOT:
• drive a vehicle (legal requirement and insurance would be void)
• cook or use electrical implements
• look after children
• sign important documents, cheques, etc
• operate any machinery
• ride a bicycle, etc
• make important decisions, etc
• use alcohol, sleeping tablets, tobacco, abuse drugs
• perform other complicated tasks or responsibilities
You will not be allowed to drive yourself home, and you will not be able to leave the clinic or facility if there is not a responsible adult that can drive you home and take care of the post-operative recovery period. You should remain in the company of a responsible adult for 12 hours following the procedure.
AM I ALLOWED TO TAKE MY HERBAL DRUGS BEFORE SEDATION?
Many patients are on herbal drugs for different reasons. It is very rare that they can interfere or cause serious complications with conscious sedation. However, it is important that the sedation practitioner knows if and which herbal medication you may be taking. The herbal drugs can influence sedation through interacting with the sedative drugs – some of the herbal drugs have a sedative effect and can potentiate the effect of the sedative drugs; or it can interfere in other ways such as increasing the bleeding tendency.
WHAT ARE THE RISKS AND DISADVANTAGES?
Very rarely you may experience:
• Discomfort or bruising at the site of injection.
• Vein irritation at the injection site. This rarely happens when an elbow vein is used.
• Allergic reaction to any of the drugs used. Allergic reactions to the sedative drugs are extremely rare.
• Nausea and vomiting, although very uncommon, may occur.
Conscious sedation is a very safe procedure, however, the very rare complications should be mentioned: depressed respiration (slowing or stopped breathing), brain damage, stroke, heart attack or even a fatal outcome. The information that you give us on the attached medical history form will assist us to decide whether you might be at risk to any known complications. Your sedationist is highly experienced in avoiding complications and is trained to deal with unexpected problems.
IF I AM CONSCIOUS DURING THE PROCEDURE WILL I NOT REMEMBER WHAT HAPPENED AFTERWARDS?
Conscious sedation induces a state of deep relaxation. In over 90% of people the drugs used for conscious sedation 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. Consequently, people who remember nothing at all, frequently report that they were “asleep” during the procedure.
IS IT STILL NECESSARY TO HAVE LOCAL ANAESTHETIC IF I HAVE CONSCIOUS SEDATION?
The conscious sedation drugs are given to relax you whilst the local anaesthetic drugs will take the pain away. The local anaesthetic injections will be administered after the sedation has taken effect.
LOCAL ANAESTHETICS DON’T WORK WELL ON ME. WILL CONSCIOUS SEDATION HELP?
Conscious sedation is an effective way of increasing the effect of local anaesthesia and it is very rare for local anaesthetic to be ineffective during conscious sedation.
WILL THE SEDATIONIST BE PRESENT ALL THE TIME?
Yes, Guy will be at your side all the time. Your pulse, oxygen levels and blood pressure are constantly monitored and recorded to ensure your wellbeing. An IV sedation trained nurse will also be present throughout.
WHAT DRUGS ARE USED? ARE THERE DIFFERENT TYPES OF IV SEDATION?
The most commonly used drug for conscious sedation is Midazolam. This is the drug that Guy uses in practice. However, there are other drugs such as Propofol and Ketamine that can be used in combination with midazolam. However, these are only used by anaesthetists or special care dentists in a hospital based clinic.
WILL SOMEONE NEED TO ACCOMPANY ME?
Yes, due to the sedative effects of the medication you will need a responsible adult to accompany you home, preferably by car or taxi.
WHY AM I HAVING SEDATION?
Conscious sedation is clearly useful for patients who have a fear or anxiety about having minor surgical or dental treatment. Sometimes, the dentist or surgeon may request the sedation in order to make the treatment more comfortable for you or to create the optimal working conditions. In dentistry conscious sedation is particularly useful for patients with a strong gag reflex, small mouth opening or those individuals with a low tolerance to pain. It is also well suited for patients who fear the administration of local anaesthetic injections (needlephobia).
DOES MEDICATION I AM TAKING INTERFERE WITH THE SEDATION?
It is important that you advise Guy of all the medication you are taking so that this can be factored into the assessment and administration of the sedation. You should continue to take your medications as usual, unless advised otherwise by the Guy
• Antihypertensive (high blood pressure) medications: continue taking these as usual.
• Asthma medications: continue taking these as usual and bring your inhalers with you.
• Diabetes medications: it is important that Guy gives you guidance here since it may be that you should have a meal, and not take oral anti-diabetic drugs the morning of the procedure. You are encouraged to monitor your blood glucose levels before the sedation and to bring these with you to the surgery.
• Antidepressants: Please inform Guy in advance if you are taking antidepressants or psycho-active drugs. These may interact with IV sedation.
Whatever medication you may be taking it is advisable to bring it to the surgery on the day of the procedure to show to Guy.