Conscious sedation involves the use of medications to help you relax (a sedative) and to block pain (an anaesthetic) during a medical or dental procedure. It is an extremely safe and effective technique for patients who need a minor medical or dental procedure or surgery, and can be used for any person who does not require a full general anaesthetic in hospital.
There are various forms of conscious sedation that provide different levels of relaxation depending on the patient’s needs and the type of procedure that is required. The sedation can range from inhalational (laughing gas), oral sedation that typically uses medications in liquid form, intramuscular sedation which is a very small injection in the arm, and intravenous (IV) sedation. At our practice we can and often do use combinations of sedation techniques to provide the highest level of relaxation and conscious sedation possible. An oral ‘premed’ is often used for children whilst intamuscular sedation for adults provides extremely efficient methods of anxiety reduction prior to a conscious sedation technique being performed. Combined with nitrous oxide, a premed can often provide profound levels of sedation where the person (even those with severe dental phobia) is completely unaware that further treatment has already commenced.
Conscious sedation allows the patient to recover quickly and return to their everyday activities soon after the procedure.
| Nitrous Oxide | Oral / Intramuscular Sedation | Intravenous Sedation |
| Use: Sedation for light general dental procedures and mild anxiety | Use: Sedation for light / moderate dental procedures and mild to moderate anxiety | Use: Sedation for moderate / extended procedures and high anxiety |
| Type: Gas | Type: Liquid by mouth or injection in the arm | Type: Liquid |
| Description: Nitrous Oxide dates back to 1844 and is the oldest dental sedation technique. Its effectiveness and safety have been proven for more than a century. It is a gas that is breathed through a mask that is placed over the nose and the nitrous oxide is carefully mixed with 100% oxygen. A common name for nitrous oxide is “laughing gas”. However when carefully administered there is no onset of uncontrollable laughter. Nitrous oxide is the ideal sedation for short dental treatments and is often combined with oral and IV sedation. | Description: Oral and intramuscular sedation is an excellent alternative method of anxiety control in dentistry. It can be used with or without nitrous oxide or as a pre-medication to IV Sedation. Developments in pharmacology have provided doctors with a range of oral drugs that produce a profound state of relaxation with a high degree of safety. Many dentists typically prescribe tablet medications as a single dose for mild anxiety. However, much more effective oral or intramuscular sedation is provided by suitably qualified doctors in liquid form as a pre-medication to intravenous sedation, or for use with and without nitrous oxide. Oral and intramuscular liquid medications are stronger and more reliable than tablet form. Oran and intramuscular sedation is an excellent choice of sedation for persons that do not wish to have or cannot have IV sedation. |
Description: Intravenous (IV) sedation is an advanced sedative technique for the comprehensive control of pain and anxiety in dental and minor surgical procedures. It provides the highest level of adjustment to the level of sedation depending on a person’s response to the medications. The level of sedation can be easily adjusted lighter or deeper by the practitioner during the entire procedure. A needle is placed into a vein of the hand or arm, and an IV line is connected. The drugs that produce sedation are then administered through this IV line and the sedative affects are very rapid. IV sedation is commonly described by people as ‘being knocked out’ as often memory of the procedure is completely impaired. |
| Benefits: A sense of relaxation and anxiety reduction is produced. Light pain relief is produced along with sedation. The dentist is able to control the rate of nitrous supply to accurately produce the desired sedative effect. Reversal of sedation occurs very quickly. Safest form of dental sedation. |
Benefits: A profound sense of relaxation may be produced. A deeper sedation than nitrous oxide is possible. Shorter recovery time than IV sedation. Inexpensive form of sedation. Some people have no memory of the procedure. NB: Oral sedation is also highly variable. Many people have different sedation responses to oral medications, particularly tablets. |
Benefits: A profound and deep sense of relaxation is produced. The doctor is able to precisely manage the amount of sedation required. In most cases, people do not remember any part of the procedure performed from start to finish. The highest level of pain control is achievable. |
Dentists and dental specialists in Australia who perform this advanced sedative technique require a post graduate qualification in Conscious Sedation and Pain Control, and a high level of skills that are endorsed by the Australian Dental Board and the Australian and New Zealand College of Anaesthetists.
Stringent conditions are also imposed on the practitioner to maintain annual recertification in advanced medical emergencies that ensures current competencies in conscious sedation techniques.
Furthermore, any practice that conducts conscious sedation must comply with guidelines similar to those imposed on a Day Surgery Hospital for monitoring equipment, recovery areas, emergency procedures and policies, staffing requirements, and procedural rooms.
Risks
Conscious sedation is historically an extremely safe technique for dental and medical procedures. However like all medical techniques and anaesthetic procedures, emergencies can occur from time to time, and may typically be when a patient reacts unexpectedly to any drug or medication given. Reactions can also occur to any medicines (prescribed, non-prescribed, herbal, or recreational) that a person may be taking. The primary risk for sedation is that there is no set dosage for every patient and one size certainly does not fit all which is why the practitioner must be very skilled and experienced at providing conscious sedation. Dr Eldridge has a long history of emergency medicine skills and knowledge far beyond those of most dental practitioners, in addition to a registered nurse with qualifications in anaesthetics always being present during the sedation procedure should the need arise for any emergency intervention. Listed below are possible side effects:
Common:
- Decreased breathing rate
- Drowsiness
- Headache
- Low blood pressure
- No or little memory of procedure
Less Common:
- Agitation
- Apnoea (stop breathing)
- Prolonged sedation
- Nausea or vomiting
Serious
- Airway obstruction
- Anaphylactic (allergic) reaction
- Cardiac arrest
- Foreign body inhalation
- Vocal cord spasm
Common and less common side effects are easily managed during and after the sedation procedure if required, and are typically of very short duration. Serious side effects are medical emergencies regardless if it is in hospital or a sedation practice. Fortunately they are very rare, however must be planned for in all cases and at all times.
If any person is considering any form of sedation no matter how ‘routine’ at another dental practice, please ensure you enquire about the emergency medical equipment and procedures that are in place, and the skills and qualifications of the dentist before proceeding.
Here at the Hobart Orofacial Pain and Special Needs Clinic we are currently the only practice endorsed to provide the full range of conscious sedation procedures.