Dental sedation

I have previously worked with the team at Woodborough House Dental Practice, Pangbourne, providing conscious sedation for dental procedures.

https://www.woodboroughhouse.com/

Sedation for dental procedures is intended to relax you before and during your procedure. It is often recommended for patient anxiety/fear or for certain procedures to provide optimal conditions and comfort.

Sedation explained - Royal College Anaesthesia information leaflet 

Your anaesthetist will place a cannula in your vein and give sedative drugs through this cannula during your procedure. Our aim is for ‘conscious sedation’ which means you will be drowsy and calm but aware of your surroundings and able to hear and respond to commands. We are not able to provide general anaesthesia or ‘non-conscious’ sedation in the dental practice setting. Your dentist will inject local anaesthetic in your gum once sedated to numb the area undergoing the dental procedure.  Importantly your anaesthetist be present throughout the procedure to ensure you are safe and to titrate your sedation dependent on your needs. We will closely monitor your blood pressure, heart rate and oxygen levels during the procedure.

The sedative drugs and techniques vary depending on the type and length of procedure. Drugs most commonly used are midazolam and propofol. Your anaesthetist can explain this more on the day if you have further questions.

As with all procedures, there side effects and potential rare complications that can occur:

·       Discomfort or bruising at the site of injection (common)

·       Vein irritation at the cannulation site (uncommon)

·       Allergic reaction to any of the drugs used (rare)

·       Nausea and vomiting (rare)

·       Conscious sedation is safe but serious medical events can occur (very rarely). These include:

o   heart problems (such as a heart attack)

o   complications involving the brain (such as a stoke)

o   breathing problems (slowing or stopped breathing)

o   There are usually underlying medical problems when this occurs, and any medical concerns can be addressed before the procedure

o   Anaesthetists are highly trained and experienced at both avoiding complications and dealing with them if they arise

Following sedation, memory of events during the procedure can be very variable between people. You may have full, limited or no memory of events. It might feel as though time has passed very quickly and may even feel like you have had a period of sleep. Whilst memory loss of the procedure might be desirable it cannot be guaranteed.

The drugs used for sedation wear off relatively quickly, but you may continue to feel the effect for a period afterwards. Following your procedure there will be a recovery period of up to 30 minutes before you can be discharged into the care of your escort. The sedative effect of the drugs will wear off gradually over the course of the day. 

My advice

·       Share any medical information including significant medical history, medication and allergies

·       Continue you normal prescribed medication. Bring any inhalers or insulin with you in case needed

·       Smoking is best avoided, and alcohol must be avoided for 24 hours before your appointment. Use of recreational drugs is not permitted for 48 hours prior to treatment.

·       Do not eat during the 4 hours before your procedure appointment time

·       Continue drinking clear fluids (not alcoholic or carbonated) until 1 hour before your procedure appointment time

·       Please wear loose fitting clothing so that we can gain access to your forearm and elbow area for cannulation and blood pressure monitoring. Avoid heavy make up, nail varnish and jewellery. Wear flat shoes as you may be slightly unsteady afterwards.

·       If you wear contact lenses, please bring your lens container with you, as you may be asked to remove your lenses.

·       Ensure that you have emptied your bladder before surgery.

·       Organise for a responsible adult escort to be present on the day of sedation. They will be responsible to take you home by car or taxi, but not by public transport. (Please note: I agree that the doctor is only able to release me from his supervised care once my escort has arrived. Any time spent waiting for my escort to arrive following the completion of the agreed sedation time will be billed at the doctors hourly rate.)

·       Plan accordingly so that there will be no children present with your escort on the day of sedation and that you will not need to be in charge of a child for 12 hours after sedation.

·       Arrange for your escort or another responsible adult to look after you for the first 12 hours after your sedation.

·       Be aware that you are not able to drive (as insurance will be invalid in this time) and advised not to operate machinery or electrical equipment for at least 24 hours after treatment.

·       Continue to take any medications as normal afterwards

·       Ensure you have bought any over the counter pain relief in advance of the day as appropriate. Paracetamol, ibuprofen and co-codamol 8/500 can all be bought over the counter at pharmacies and we are unable to provide these for you on the day.