Intravenous Conscious Sedation and General Anesthesia

By Brian J. Gray, DDS, MAGD, FICOI

Most people with mild to moderate levels of dental fear can successfully be managed with techniques of conscious sedation such as oral (see article "Dental Anxiety and its Management") and inhalation sedation (see article "Nitrous Oxide-Oxygen Sedation"). As effective as these techniques are, some people still will be unable to tolerate their planned dental treatment. Two additional techniques may prove effective in these situations.

Intravenous (IV) Conscious Sedation

Injection of sedative drugs directly into a vein provides a very effective and safe patient management technique. Patients receiving IV conscious sedation are quite relaxed, but remain conscious throughout the procedure. A benefit of many IV sedative drugs is the degree of amnesia they produce. Though conscious, the patient has little or no memory of the dental procedures carried out. The patient's perspective is "I was asleep."

Dentists who employ IV conscious sedation have received specialized advanced training and certification by their state Board of Dental Examiners.

Commonly used drugs include Valium, Versed, Fentanyl, and Demerol either alone or in combinations selected by the doctor.

During the procedure, monitoring devices will be attached to the patient. These devices monitor the effectiveness of breathing (pulse oximeter), blood pressure, and heart rate, increasing the safety of the procedure.

Patients receiving IV conscious sedation are not permitted to leave the dental office unescorted at the conclusion of their treatment.

General Anesthesia

For the very few fearful patients in whom conscious sedation proves ineffective, general anesthesia will be required. Additionally, general anesthesia will be effective in any patient with severe physical or mental disabilities unable to be managed with conscious sedation.

The dentist who treats patients under general anesthesia will employ a highly trained and certified dentist anesthesiologist, medical anesthesiologist, or, in some cases, nurse anesthetist, whose sole responsibility is to ensure the safety of the sleeping (unconscious) patient while the dentistry is being done.

Dentists administering general anesthesia have received a minimum of two years of specialized advanced training and have been certified by their state Board of Dental Examiners. Monitors, some of which evaluate breathing, blood pressure, and heart rate, will be employed to help ensure the safety of the procedure.