In modern dentistry, IV sedation is considered as a procedure which is absolutely safe for the patients. However, as with any medical procedure, there are some possible side effects and risks associated with intravenous sedation. Some of them are common with other sedation methods, while some are specifically related with the intravenous administration of the sedative medications.
The main risks and possible side effects of IV dental sedation include:
Over-sedation. The most serious risks and complications associated with IV sedation are mostly related to the risk of over sedation. Reaching a deeper level of sedation than the desired one can be dangerous especially for certain groups of medically compromised patients.
If during the procedure there is any indication that the patient has lost consciousness, the dentist must stop the administration of sedative and take measures to revive the patient into conscious state. In severe cases, the sedation should be reversed by using a benzodiazepine antagonist.
Respiratory depression. Depression of the respiratory function is a potential side effect of the sedatives drugs used in IV sedation dentistry. The risk is much higher in case of over-sedation, if the patient falls into deep sedation. The breathing function and the oxygen saturation in the blood must be monitored continuously by clinical observation and by using a pulse oximeter. If there is any sign of respiratory depression, this can be managed by encouraging the patient to breathe until the overdose wears off. In more severe cases, supplemental oxygen may be required.
Hematoma formation. An hematoma is a localized swelling that may occur sometimes at the site where the vein was punctured as a result of blood leaking from the blood vessel into the subcutaneous tissues. Formation may occur at cannulation, as a result of multiple vein wall punctures or when the cannula is removed as a result of insufficient pressure being applied to the site.
Amnesia. The amnesic effect of iv sedative medications is a common side effect of diazepines considered as a benefit from most patients who do not want to remember the traumatic details of an invasive dental treatment. However for some patients not remembering what happened during the procedure can make them feel extremely uncomfortable.
Sexual fantasies. It has been reported in several cases after an IV sedation procedure, that the sedated patient has memories of sexual nature, although there is no memory of the treatment itself. It is considered to be a side effect of benzodiazepines used as sedative drugs, although the mechanism is unclear. In some cases these sexual fantasies appears so real, that legal action was taken against the IV sedation dentist. Consequently, no member of the dental team should ever be left alone with a sedated patient, to prevent false allegations.
Despite the several benefits that IV sedation can offer, this method is not used as often as oral or inhalation sedation, mainly due to the limited availability of IV services by dentists, the higher cost, and the need for establishing intravenous access, which are considered as the main disadvantages of IV sedation.
Intravenous access. The administration of the sedative drug through a vein means that first a needle (and tubing) must be put in the vein. This can make needle phobic patients to feel extremely uncomfortable. The solution is to get the patient initially relaxed with light nitrous oxide sedation and then establish the vein access. Additional injections are also required for delivering local anesthesia, but it rarely is a problem because the patient is already sedated.
Escort required. Recovery from the effects of IV sedation dentistry may take up to 24 hours. You must arrange for someone to escort you home after the end of treatment.
Cost of IV sedation. The cost of IV sedation dentistry is much higher than other sedation methods ranging from $200-$400 per hour. mainly due to the increased training and licensing requirements for the sedation dentist, and the need of a second trained person to be present during the procedure for monitoring the patient.
Availability. Due to the dentist licensing restrictions and advanced training required, IV sedation is not as commonly available as other conscious sedation techniques such as oral sedation.