Dr. Musto

Practice Limited to Periodontics and Dental Implants

920 Wyoming Avenue, Suite 203, Forty Fort, PA 18704

507-283-3611

Intravenous Sedation (Conscious Sedation)

Conscious sedation, produced by the administration of certain medications, is an altered level of consciousness that still allows a patient to respond to physical stimulation and verbal commands, and to maintain an unassisted airway.

Purpose

The purpose of conscious sedation is to produce a state of relaxation and/or pain relief by using benzodiazepine-type and narcotic medications, to facilitate performing periodontal and dental implant procedures.

Description

Once it has been established that the patient would be a good candidate for conscious sedation, just prior to the surgery or procedure, the patient will receive the sedating drug intravenously. A clip-like apparatus will be placed on the patient's finger to monitor oxygen intake during the sedation. This oxygen monitoring is called pulse oximetry and is a valuable continuous monitor of patient oxygenation.

Dosing of medications that produce conscious sedation is individualized, and the medication is administered slowly to gauge a patient's response to the sedative. The two most common medications used to sedate patients for medical procedures are midazolam and fentanyl.

Fentanyl is a medication classified as an opioid narcotic analgesic (pain reliever) that is 50 to 100 times more potent than morphine. Given intravenously, the onset of action of fentanyl is almost immediate, and peak analgesia occurs with in 10 to 15 minutes. A single dose of fentanyl given intravenously can produce good analgesia for only 20 to 45 minutes for most patients because the drug's distribution shifts from the brain (central nervous system) to peripheral tissues. The key to correct dosage is titration, or giving the medication in small amounts until the desired patient response is achieved.

Midazolam is a medication classified as a short-acting benzodiazepine (sedative) that depresses the central nervous system. Midazolam is ineffective for pain and has no analgesic effect during conscious sedation. The drug is a primary choice for conscious sedation because midazolam causes patients to have no recollection of the medical procedure. In general, midazolam has a fast-acting, short-lived sedative effect when given intravenously, achieving sedation within one to five minutes and peaking within 30 minutes. The effects of midazolam typically last one hour but may persist for six hours (including the amnestic effect). Patients who receive midazolam for conscious sedation should not be allowed to drive home after the procedure.

Monitoring

Patient monitoring during conscious sedation must be performed by a trained and licensed health care professional. This clinician must not be involved in the procedure, but should have primary responsibility of monitoring and attending to the patient. Equipment must be in place and organized for monitoring the patient's blood pressure, pulse, respiratory rate, level of consciousness, and, most important, the oxygen saturation (the measure of oxygen perfusion inside the body) with a pulse oximeter (a machine that provides a continuous real-time recording of oxygenation). The oxygen saturation is the most sensitive parameter affected during increased levels of conscious sedation. Vital signs and other pertinent recordings must be monitored before the start of the administration of medications, and then at a minimum of every five minutes thereafter until the procedure is completed. After the procedure has been completed, monitoring should continue every 15 minutes for the first hour after the last dose of medication(s) was administered. After the first hour, monitoring can continue as needed.