Continuous monitoring of any patient undergoing IV sedation dentistry is critically important for ensuring the safety of the procedure. During IV sedation procedures, patients are less aware of their body functions. If something is abnormal, the patient may not be able to understand on its own, or/and communicate it to the dentist. It is the IV sedation dentist’s (and staff) duty to monitor the patient’s status throughout the procedure.
The most important body functions that are monitored during an IV Sedation procedure are breathing, pulse, blood pressure and oxygen saturation. These can be checked by a combination of clinical monitoring and use of electronic equipment. Since the dentist is occupied with performing the dental surgery, a second person from the dental staff must monitor the indications at all times and alert the dentist if something looks abnormal.
The IV sedation dentist and at least another person must be trained to perform Cardio Pulmonary Resuscitation (CPR) in case of an emergency.
Continuous venous access must be maintained until the patient has completely recovered, in order to enable the fast administration of an antagonist drug to reverse the action of the sedation agent if needed.
The clinical observation of the patient by the IV sedation dentist can provide an early warning for potentially dangerous problems. During the IV sedation procedure the dentist will constantly monitor:
Sedation level – Consciousness. At no time should the patient lose consciousness during IV sedation. The level of sedation and consciousness can be defined by the patient’s ability to respond to verbal commands, therefore every few minutes the dentist asks the patient to make a small move or answer a question. The patient must remain conscious but relaxed, cooperative and responsive.
Pattern and depth of respiration. Proper breathing is monitored by observing the rate and depth of chest and abdominal movements, in order to notice any abnormality in the pattern of respiration. Respiratory depression is the main risk of sedative medications such as benzodiazepines, especially in the elderly or in medically compromised patients.
Skin color. A change in the skin color can be an indication of change in body functions. A more pale color may be due to a drop in blood pressure, while a bluish color may be a sign of hypoxia resulting from respiratory depression that requires immediate action from the dentist.
Comfort level. The facial expression of the patient is also a good indicator of the level of comfort that the patient experiences.
During the IV sedation procedure, monitoring devices are attached to the patient to complement clinical monitoring. These devices can monitor the effectiveness of breathing, heart rate and blood pressure, increasing the safety of the IV sedation procedure. The devices must be attached to the patient and switched on prior to the administration of any sedative so that the normal readings for the specific patient can be noted.
Oxygenation and pulse (Pulse oximetry). Oxygenation of the body is by far the most important function to monitor during IV sedation dentistry procedures. Oxygen levels in the blood are always monitored, with the use of a pulse oximeter. It is a non-invasive device (clips onto a finger or an earlobe) providing rapid and accurate recording of arterial oxygen saturation and pulse rate.
By using a pulse oximeter, both the respiratory and cardiovascular function are adequately monitored. The device can detect changes in oxygenation that may be not noticed by clinical observation, and provide early warning in case of respiratory depression. Oxygen saturation levels under 90% must be treated as potentially serious.
Heart function. The use of electrocardiographic monitoring is not normally required, but it may be helpful in case of patients with cardiovascular problems or increased cardiac risk. Electrocardiographs are more likely to be used when sedation is performed in a hospital environment.
Blood pressure. Blood pressure is usually measured for reference before and then after the procedure. There is no need for continuous monitoring of blood pressure, unless there are medical reasons to do so.