Intravenous Sedation

Intravenous sedation (IV) entails the administration of sedative agents directly into the vascular compartment. The use of IV sedation in a dental office requires additional advanced training beyond the curriculum of dental schools. The most common parenteral sedation technique in the general dental office involves the use of a benzodiazepine (e.g., diazepam or midazolam) alone or in combination with an opioid (e.g., fentanyl or demerol). Because of potential additional risks, other techniques such inhalation should be considered first.

• Advantages A major advantage of IV sedation is that it allows for titration. It provides for rapid onset (20-25 seconds) and shorter recovery compared to oral sedation, but longer than nitrous oxide/oxygen. In an emergency, it provides ready access to a vein. Finally, patients will often have vague or no recollection of the procedure or the length of time they were under treatment.

• Disadvantages The need for access to a peripheral vein and the anticipated pain may alarm the severely anxious patient. The use of nitrous oxide/oxygen as a pre-sedative may prove useful in this situation. A potential concern is local complications at the injection site. Other disadvantages include the need for additional training on the part of the clinician and the need for a responsible adult escort for the patient.

• Indications The principal indication for the use of intravenous sedation is the management of moderate to severe anxiety, where oral and/or nitrous oxide/oxygen may not be effective. It is also indicated when longer, more involved procedures are planned such as impacted third molar extractions or when amnesia is desired.

• Contraindications Intravenous sedation should not be administered by unqualified, i.e., untrained providers. It is also contraindicated during pregnancy and the extremely obese - due to difficulty to maintain patent airways or access to the airways in case of an emergency.