Wednesday, August 5, 2009

IV Sedation

Outpatient Intravenous Sedation.

No Hospitalisation. Sleep Through Your Surgery, Wake Up, Walk Home

S$600 per hour (includes cost of drugs and anaesthetist charges)

After 17 years in private practice, I have met numerous patients who tell me they have "dental phobia". In reality, most people do not have a genuine phobia for dental treatment. By "dental phobia", they usually mean that they just want to be pampered.

Well, whether it's true dental phobia or patients just want to be pampered, we can reduce anxiety with intravenous sedation. If you wish to be pampered and have no "budget problems", we recommend IV sedation for wisdom tooth surgery, implant surgery and even difficult extractions. "Intravenous" means that the drug is injected into a vein, usually in the back of the hand. After the needle is inserted, a plastic tubing is left in place for continuous infusion into the vein. The tube stays in place throughout the procedure.

The patient's pulse and oxygen levels are measured using a pulse oximeter. This gadget clips onto a finger and measures the pulse and oxygen saturation of the blood. It will warn the dentist and anaesthetist if your oxygen level is low. To be kiasu, we would give our patients supplemental oxygen through a nasal cannula throughout the procedure. The device also comes with a cuff around the arm to measure blood pressure at regular intervals.

What drugs are used?

The most commonly used drugs for IV sedation are benzodiazepines. These are sedative drugs sometimes prescribed as sleeping pills. Examples include Dormicum. Someone who has been consuming sleeping pills regularly for years may not react well to benzodiazepines. The patient may be "knocked out" when the drug is administered in a bolus but effects of sedation are gradually lost as the operation progresses.

Propofol is usually preferred for a deep and a consistent level of sedation throughout the operation. The advantage of Propofol is in its rapid recovery time of less than 5 minutes. Because of the short duration of its action, the drug must be continuously administered. We do this by pumping Propofol using an electric infusion pump. The dose rate is set by the anaesthetist.

What about safety?

IV sedation is very safe when carried out by an anaesthetist. Statistically speaking, the mortality rate is literally 1:1 million. In contrast, the mortality rate for general anaesthesia (GA) is 1:598,000.

However, contraindications include pregnancy, known allergy to the drugs used, alcohol intoxication, CNS depression and some instances of glaucoma. Cautions include psychosis, impaired lung or kidney or liver function, and advanced age (above 70). Heart disease is generally not a contraindication.

What are the 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.

* The drugs produce amnesia for the procedure. The patient forgets the trauma of the operation even though he/she may not be unconscious.

* The effects of intubation and nausea from GA are not found in sedation. No fasting and long preparations are required before the operation.

Are there any disadvantages?

* You need to bear with the initial discomfort of having a needle inserted into your hand.

* It is possible to experience complications at the site where the needle entered, for example haematoma (a localised swelling filled with blood).

* Patients may become dependent on IV sedation such that they want IV sedation even for non-invasive procedures like fillings.

* Recovery from IV administered drugs is not complete at the end of dental treatment. You may need to be escorted by someone who can take care of you.

After IV Sedation:

(1) Have a companion (sorry, we don't provide) 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. porridge or bread.

(5) If you experience giddiness, lie down for a while or have a glass of isotonic drink.

(6) Don't drink alcohol for the rest of the day.

(7) Take medications as directed by your dentist.

(8) If you have any unusual problems, call your dentist.

No comments:

Post a Comment