In the last ten years there has been a growing demand for and an increasing use of sedation procedures for various out-patient surgical treatments, especially in the fields of Odontology and Esthetic Medicine.
This has encouraged different groups of Anesthetists from different regions of Spain to perfect sedation techniques and the surgical professionals to increase the complexity of their operations.
People are generally afraid of anesthesia and dentists. But, today, due to the advances technology we are now able to provide monitoring and security to patients in an out-patients department just as well as in an operating room.
Generally speaking, the anesthetic technique used by the specialist in Anesthesiology and Reanimation is that of CONSCIOUS SEDATION through the intravenous application of medicines.
Before administering conscious sedation for dental or esthetic surgery treatments, the patient should be evaluated by an Anesthetist, who will explain the appropriate anesthetic procedure to be used for each case and each patient.
Types of patient and their type of sedation
Patients who are candidates for CONSCIOUS SEDATION are ASA I-II, that is, according to the classification of the American Society of Anesthesia (ASA), they are healthy patients (ASA I) or patients with relatively minor illnesses or illnesses which are well controlled, such as Hypertension or Diabetes (ASA II). Patients at ASA III level will need to have a more detailed evaluation so that the advantages and disadvantages of the procedure can be weighed up.
Uses of conscious sedation
- Conscious sedation can be usefully applied for longer treatments which previously would have needed to be done over 3 or 4 sessions.
- It also helps to reduce anxiety in the patients, e.g., the pain of local anesthesia in the mouth which is often described as being very troublesome.
Conscious sedation, as the Spanish Collegial Organization of Dentists (Organización Colegial de Dentistas de España) declares, should be carried out by Doctors who are specialists in Anesthesiology and Reanimation. These Anesthetists are fully experienced in the daily use of sedatives and the reanimation of the aforementioned patients.
During the treatment in dental clinics or esthetic clinics like ours, the Anesthetist will be present throughout the entire operation, maintaining the sedation, monitoring the vital signs of the patient and, above all, controlling the Level of Sedation, Blood Pressure and Pulse Rate.
Good conscious sedation will always try to:
- Maintain the reflexes of the respiration system.
- Maintain the level of consciousness or response to verbal stimuli.
- Ensure that the patient DOES NOT respond to painful stimuli.
The sedatives administered have a very short term of action, so that once the operation is over, the patient recovers quickly and can go home without any problems.
To sum up, the patient who receives intravenous conscious sedation finds themselves in a state of relaxation without fully losing consciousness, collaborating with the odontologist. The sedation may provoke slight amnesia and the medicines used during sedation reduce surgical bleeding, because they lower the blood pressure. Furthermore the immediate postoperative period is much easier as the patient leaves the dental clinic with the intravenous analgesic and anti-inflammatory medicines already inside them, administered through the same needle used in the sedation.
What precautions must I take before receiving conscious sedation?
- Dietary precautions: you should not eat or drink anything after these times: 3 hours for liquids EXCLUDING milk or dairy products or juices with pulp, 6 hours for light meals and 8 hours for full meals.
- Consult the Anesthetist if you are taking medication for Hypertension, Diabetes, Anticoagulants or Bronchodilators.
- Complementary tests: there are no medical reasons which justify the systematic undertaking of complementary tests in healthy patients or patients with illnesses which are well controlled by their GP.
INFORMATION FOR THE PATIENT. The Anesthetist will give you:
- Information about the characteristics of the Sedation and possible alternatives.
- Information about any complications and an explanation of possible risks.
- A personalized explanation for each patient.
- Information about signing the consent form.
To close, when using conscious sedation, we always try to ensure that the patient feels content and does not suffer at all during the dental or esthetic treatment.
And do not forget that the Anesthetist who is going to administer your sedation, as well as being a specialist in Anesthesiology is also familiar with the different techniques of Sedation, because our professionals are pioneers in sedation treatment in dental clinics.
By Dr. Jaime Massot, anesthetist.