What is Intravenous Sedation?
Intravenous sedation is a supportive procedure in addition to the primary treatment aimed at managing patient anxiety. It involves the introduction of a canula into a small vein in the arm to allow administration of a sedation drug, called Midazolam, directly into the blood stream to achieve instant sedation, relaxation, loss of conscious awareness and prevention of the formation of memory during the time the drug is active. While the drug remains active, the patient remains disinterested in what is happening, is unaware of the procedure but can be aroused to a lighter state to achieve basic communication if required. The patient continues to breath normally and generally drifts into a light sleep-like state while the primary treatment is provided. The sedation drug can be administered repeatedly throughout the treatment to maintain this ideal state until near the end of the treatment. As the drug is metabolised relatively quickly, the discontinuation of the further administration of the drug will result in the patient becoming less and less sedated and gradually becoming more responsive and aware of their surroundings. This recovery allows for them to be discharged home with their carer or escort who should remain with them for the first 6 hours after discharge. The commonest first question asked by sedated patients at the end of the treatment is “have you done it yet”.
Regulations and Guidelines….
The provision of intravenous sedation is carefully regulated by the Australian Health Practitioner Registration Authority, (AHPRA) and only approved for use by suitably qualified practitioners in facilities that are also approved in terms of the facilities, equipment and staff. At NQ Surgical Dentistry, we provide intravenous sedation in a safe environment using approved techniques and conform to the regulations and guidelines governing the use of sedation as stipulated by the Austalian and New Zealand College of Anaesthetists. Dr Colin Priestland is endorced by the Australian Health Practitioner Regulation Authority (AHPRA) to provide conscious sedation.
Qualification for providing sedation….
The AHPRA endorcement confirms Dr Priestland has undergone training in the use of intravenous sedation and other techniques for sedation and pain control and in the treatment of medical emergencies. Endorcement also indicates that he has attended and passed annual training and examination in intravenous sedation and the management of medical emergencies that may be associated with the practice of sedation. His sedation nurses are highly trained and qualified registered nurses who are current in advanced life support (ALS).
In addition to satisfying the current regulations of the Australian and New Zealand College of Anaesthetists (PS09), Colin has been practicing intravenous sedation since 1986, helping many anxious and phobic patients willingly accept dental and surgical care who would otherwise have required hospital based general anaesthetic treatment.
Colin works with two sedation nurses in the practice; Lauren Camilleri is a clinical intensive care and neonatal intensive care nurse of over 25 years experience and Andrea Steinhardt is an experienced anaesthetic nurse holding a Diploma in Anaesthetics and Recovery. They work with Dr Priestland as a team and have done so for a number of years. Together they maintain full patient monitoring using a combined Electrocardiograph/Pulse Oximeter/Capnography unit, with regular automated non-invasive blood pressure monitoring throughout the sedation procedure and constant monitoring of the oxygen saturation of the blood. Such careful monitoring is essential to ensure the safe practice of sedation and to ensure patients are maintained at the ideal level of sedation to achieve the treatment they need without any anxiety or awareness of the procedure.
The facilities, the staff and training….
The practice facilities have been assessed, including the equipment, emergency drugs and staff training. Our facilities and team are approved for the provision of in-practice intravenous sedation for the conduct or dental and oral surgery. Dr Colin Priestland is a member of the Australasian Society of Dental Anaesthesiology and he conforms to their guidelines for practice.
Anxiety is very common….
Many patients present to dentists suffering from a basic level of anxiety that makes it difficult for them to accept treatment without suffering from nervousness, even possibly palpitations and sweating. Such experience is not pleasant and often contributes to keeping patients away from the dentist until such time as they suffer from severe dental pain, dental infection or other dental disease. The longer a condition remains untreated, the more severe is the condition and the more extensive is the surgical procedure to treat the problem.
This degree of anxiety is not uncommon but is something that is completely unnecessary today with the availability of intravenous and inhalational sedation and effective local anaesthetics widely available. Patients who would like to receive good quality dental care without any anxiety can contact our practice for a consultation.
What to expect at the first appointment….
At the first appointment there will be no treatment offered; it will be solely a consultation at which there will be an open discussion between the patient and Dr Colin Priestland to define the things that make the dental experience unpleasant for the patient. Once Colin has a detailed understanding of the patient’s fears, he can explain how he is able to use various techniques to control and eliminate anxiety and make routine dental care or even surgical care acceptable and easy for the patient to accept. A full explanation will also be given to explain how sedation works and what to expect. At this initial consultation it is imperative that any medical history of illness, operations or medications taken, is openly discussed with Dr Colin Priestland. An assessment of the patient’s suitability is made and may involve a check on blood pressure or arrangements may be made for blood tests to investigate any issues that may interfere with sedation safety. All patients are classified under the American Society of Anaethesiology (ASA) disease classification system. This helps ensure that only patients suitable for in practice sedation are treated in this way and that all other patients with more serious systemic illness are treated in a hospital setting.
Sedation is not always the answer….
Of course not every dental and surgical procedure can be provided under sedation for all patients. It is important to assess a patient’s medical history before making any decision on the best way to manage their care. Sometimes it may be better to provide some types of treatment under a general anaesthetic as a day case. This means the patient is rendered completely unconscious in an operating theatre by a specialist consultant anaesthetist and after recovery they must remain in the day surgery unit for 2-3 hours before they are sufficiently recovered to be released to the care of their chosen escort.
Preparation for your sedation appointment….
Patients should be aware that they must follow detailed guidelines to ensure their safety while sedated and to allow good patient care and monitoring.
- Patients must not eat any food for 6 hours and must not drink for 6 hours before their sedation. This is important to avoid a patient vomiting while under sedation.
- Flat footwear must be worn to minimise the possibility of tripping. Thongs and high heeled shoes must not be worn for the same reason.
- Comfortable, loose clothing should be worn to enable access to the arms easily without restriction of blood flow, therefore loose sleeves are advised.
- A loose warm jumper is sensible as the operating room is kept cool during surgery.
- No nail varnish and no false nails should be worn as this prevents the use of some of the monitoring equipment.
- Patients should not smoke for 24 hours before treatment.
- Patients attending for treatment under sedation must have arranged for an escort to take them home and remain with them for a minimum of 6 hours after sedation. An escort’s consent form will be required prior to providing sedation.
It is best if patients understand that for the remainder of the day and part of the next day they may still be affected by the sedation drugs. For this reason patients are all informed that they should not perform any of the following tasks:
- drink alcohol or take sedative drugs for 24 hours
- take exercise (running/sport) for 24 hours
- drive any vehicle or ride a bike for 24 hours
- use machinery for 24 hours
- work in a Health and Safety regulated workspace for 24 hours
- make legally binding decisions nor sign legal documents,
- be the sole adult caring for children/minors for 24 hours
- use social media for 24 hours
- smoke for 10 days to avoid post-operative infection.
If you suffer from anxiety over any dental or oral surgical treatment and are fearful of the treatment you require, you may wish to discuss the use of sedation to make the experience more pleasant. You can discuss this with your dentist and ask for a referral to Dr Colin Priestland at NQ Surgical Dentistry for the treatment or if you are a patient who is scared of basic dental care or the dental practice environment, you may wish to come directly to Dr Colin Priestland and discuss your treatment needs and how you can receive the care you need with the minimum of fuss and free of anxiety.
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Our friendly, knowledgable and experienced team will be happy to help you.
Contact the friendly team at NQ Surgical Dentistry today on (07) 4725 1656 or call in to see us at 183 Kings Rd, Pimlico QLD 4812
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