• What is conscious sedation

The aim of sedation is to make you comfortable, totally relaxed and safe during a procedure. Administration of the sedatives and analgesia results in you becoming drowsy and sleepy, pain free, and probably amnesic such that you will have very little recollection of the procedure. Communication is possible if necessary during the operation because even though you are completely relaxed and unconcerned, you are not completey unconscious at any point in time. Your vital signs e.g. blood pressure, breathing, pulse rate, etc are monitored throughout the procedure to ensure your safety, and a sedationist will stay with you all the time. Recovery after sedation is much faster than with general anaesthesia.

 

• Are there different levels of sedation

There are three different levels of sedation that are defined and recognized internationally. The three sedation levels recognized in the UK today include:

 

• 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.

 

• Moderate Sedation or Conscious Sedation: This is where the patient is more deeply sedated, becomes drowsy and sleepy (and may even sleep intermittently), is 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 ..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.

 

• 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. Higher doses of drugs administered with general anaesthesia are associated with higher risks.

• Side effects: due to the lower dose of sedative/anaesthetics the frequency of side effects are minimal when compared to general anaesthesia where the side effect profile is much more substantial.

• 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 done inside a hospital in an operating theatre.

 

• Is conscious sedation an option for all patients

As with any anaesthetic, the suitability of conscious sedation is determined by the patients'age, health and need, as well as by the procedure being performed. In the first instance, indications for conscious sedation include:

 

• very anxious patients - sedation calms the patient and overcomes their fear and 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

• procedures in difficult adults and children for procedures that may not be particularly painful, but require them to be very still

• from a medical perspective, adults who are healthy, or have controlled medical conditions eg hypertension, diabetes, asthma which are adequately controlled, can qualify for sedation. Patients with significant or uncontrolled medical conditions (eg severe heart disease, morbid obesity, etc) need to be assessed on a case by case basis as to their suitability for sedation, where it may be an option to perform the procedure within a hospital setting.

• for children, sedation can be an option on a case by case basis according to an assessment by an appropriately trained sedation practitioner.

 

• 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 for two (2) hours prior to the procedure

• all patients may have clear liquids until two (2) hours before 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. The drugs will also contribute towards a pain free period after the operation.

 

• How long does it take to recover after the operation and how soon can I go home

The recovery time depends on the drugs used, the patient's individual response to the drugs, and the time spent under sedation. The drugs and doses that are used for sedation have a rapid onset and offset. After the administration of the sedative drugs is stopped, recovery is swift and in most cases less than about 30 minutes, which is the time that you will need to remain at the clinic before being allowed to go home with your escort.

 

• 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 postsedation nausea & vomiting (0.7%).

 

• How should I spend my time at home recovering after the operation

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 (insurance will be void)

• cook or use electrical implements

• operate any machinery

• sign important documents, cheques, etc

• look after children

• 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. So it is therefore obviously important that you let your sedationist know if you are taking herbal medications, and if possible consider stopping them a week or two before the procedure.

 

• What are my options

You may choose:

• Not to have the treatment

• Have the treatment with local anaesthesia only

• Have the treatment under conscious sedation and local anaesthesia at the surgery

• Have general anaesthesia in a hospital enviroment

 

• What are the risks and disadvantages

Very rarely you may experience:

• Discomfort or bruising at the site of injection.

• Vein irritation (phlebitis), which can last a week and can be painful. 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 why shall 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 anaestaethic will be administered after the sedation has taken effect.

 

• What drugs are used? Are there different types of IV sedation

The most commonly used drug for conscious sedation is Midazolam, which belongs to the same family of drugs as Valium.

 

• What about taking medication before conscious sedation

Please continue to take your regular medication at the usual times with a little water. If you suffer from diabetes or have other dietary problems please discuss this with your sedationist before your appointment.

 

• Will someone need to accompany me

Yes, due to the sedative affects of the medication you will need a responsible adult to accompany you home, preferably by car or taxi.

 

• What happens if I do not have anyone to take me home after the appointment

To comply with guidelines and for your own safety we must insist that you have a responsible adult to take you home after your appointment. In the event that you have no escort on the day of the sedation, your appointment may be cancelled.

 

• How long will I be under conscious sedation

The length of your appointment will depend upon the procedure. There will be a recovery period of 20 - 30 minutes before you are discharged into the care of your escort. The sedative effect of the drugs will gradually wear off during the course of the day. Most patients are well enough to return to their normal activities within 24 hours depending on the nature of their work.

 

• What types of procedures are suitable for sedation

More information on the procedures performed with sedation can be found on the treatments section of the website.

 

• Why am I having sedation

Conscious sedation is clearly useful for patients who have a fear or anxiety about having minor oral surgery or dental treatment. Sometimes, the dentist 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.

 

• Does medication I am taking interfere with the sedation

It is imperative that you advise the sedation practitioner of all the medication you are taking so that this can be factored into your assessment and adminstration of the sedation. You should continue to take your medications as usual, unless advised otherwise by the sedationist.

 

• 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 the sedation practitioner 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 operation. You are encouraged to monitor your blood glucose levels before the sedation, and bring these with you to the surgery.

• Antidepressants: an increasing number of patients are nowadays on antidepressants not only for the treatment of depression, but also to treat pain. It is of utmost importance that you inform the sedation practitioner of any antidepressants you may be taking, since certain classes of antidepressants can interact with the sedative agents, and it may be required that you stop these for a few days prior to the procedure.

 

Whatever medication you may be taking it is advisable to bring it to the surgery on the day of the operation to show to the sedation practitioner.