IV Sedation For Oral Surgery

IV sedation involves administration of several medication intravenously. Initially, nitrous oxide gas is given to relax you, and then a very small IV needle or catheter is placed with minimal discomfort. Patients are monitored as the medications are slowly given to achieve the right level of sleepiness. This takes no more than two to three minutes. Once you are asleep, the surgeon will start the procedure. IV sedation is very different from general anesthesia which is given in a hospital setting and requires intubation.

Who Administers IV Sedation?

IV sedation will be administered by Dr. Kazemi who is trained and licensed for this procedure. He received extended anesthesia training in a hospital setting during his residency and is well studied on anesthesia protocol, its medications, emergency and airway management, and post-anesthesia recovery.

Feeling Anxious about Having an IV?

It is not uncommon for some patients to feel nervous about getting an IV. Here is what we do to make it more comfortable for you:

  • The IV catheter is very thin and feels like a small and very quick prick.
  • We give you some nitrous oxide first to help you relax; this way, you will be less aware when the IV is placed.
  • Dr. Kazemi is highly skilled and experienced in IV techniques and is very gentle.

Medications Used for IV Sedation:

Medications typically include Versed (Benzodiazapine), Fentanyl (a narcotic), and Brevital (a short-acting barbiturate). Medications are given as a “cocktail”, which means they are combined but each is given in small doses to avoid risks and complications while achieving the desired anesthesia level.

IV Sedation Safety:

IV sedation is a very safe and predictable option for healthy patients when administered by an experienced clinician with proper training and accepted protocol.  The patient is continually monitored (pulse oximeter, heart rate, EKG, Blood pressure, Capnography) during anesthesia and emergency equipment is kept on hand. The medications used have a long history of safety and are short-acting.  Anesthesia is also safe In patients with respiratory problems or cardiovascular disease, providing that precautions are taken. To avoid possible airway compromise, patients with severe upper respiratory concerns, such as severe cold with stuffy nose and productive cough are advised to postpone the surgery until they feel better.

Our facility is equipped with emergency equipment and medications and the entire team is trained to manage any possible complications quickly and properly. The surgeon is CPR and ACLS certified and can effectively and quickly manage any complications that may arise. Suburban Hospital is in close proximity in the event additional assistance is required. Our facility is licensed by State of Maryland to provide IV sedation anesthesia.

Our monitoring also includes capnography, which became a requirement by AAMOS effective January 2014.

Is It Possible to Wake During Anesthesia?

The anesthesia is given to keep you in a steady state of sleepiness and avoid waking up during surgery. This is accomplished by administering small increments of the medication in regular intervals during surgery. Very rarely, a patient might briefly wake up during a procedure. If that happens, additional medications are quickly given and the patient will fall asleep again within a few seconds. This short and brief awake period is rarely recalled by the patient. Some patients have a very high tolerance to anesthesia medications and remain somewhat alert, even after receiving a considerable amount of medication. In these patients, surgery will be done under a lighter state of anesthesia, but patients remain quite comfortable.

Possible Side Effects:

Anesthesia is remarkably safe when administered with proper protocol, monitoring, medications, and expertise. Rare potential complications include nausea, vomiting, respiratory depression, clinically significant changes in blood pressure, and cardiovascular problems. Complications are prevented by taking a good patient medical history and examination, taking proper precautions in those with certain illnesses, continuous monitoring, supplemental oxygen, judicious use of medications, availability of emergency medications and equipment, and a well trained surgeon and team.

Nausea following surgery is the most common side effect with IV sedation. A prophylactic dose of an anti-nausea medication (such as Zofran) can be given during the procedure to help decrease nausea in susceptible patients. It often resolves spontaneously by the evening or the next day. If mild, carbonated soda can help resolve it. If it is more severe, anti-nausea medication may be prescribed in either pill or suppository forms. Also, you might consider not taking strong narcotic pain medications until nausea has subsided. Ibuprofen or Tylenol can be substituted during this time.

Allergies to anesthesia medications are extremely rare.

Recovery from Anesthesia:

As soon as the procedure is completed, you will immediately wake up, often in response to  a simple tap on the shoulder. You can walk a few minutes later with help of assistants to the recovery room where you will relax for 30 to 45 minutes before going home.  You cannot drive after surgery and a responsible adult must take you home. You might feel sleepy for the rest of the day. It’s best to take a nap at home and just relax. By the next day, most people have recovered from the effects of anesthesia and can return to some normal activities. The overall time for recovery can vary based on a patient’s tolerance and physiology, anesthesia time, and the amount of medications administered.

Returning to Work, School, or Other Activity:

Most patients return to work, school, or some normal activities one to two days after surgery. Most schedule their surgery on a Friday and can be ready to go back by that Monday. There is no problem with traveling or flying the following day, although it’s best to rest for a day or two. Of course there are always individual variations in overall recovery.

Other Medications Given During Anesthesia:

  • Steroids: minimize swelling; given as single IV dose
  • Antibiotics: If there is existing infection
  • Anti-nausea mediation (e.g. Zofran)