Intravenous sedation in dentistry and oral surgery.

IV administration is the most precise and effective means of sedating a patient. Its desired effect is a comfortable and cooperative patient whose pain is alleviated by regional local anesthesia. It requires a patient who understands the difference between being lightly sedated and unconscious. Its primary purpose is to diminish anxiety and apprehension rather than to obtund protective reflexes. At all times, the patient should remain conscious and appropriately responsive to questions or commands. This state can be readily achieved in most patients by carefully titrating a single drug such as diazepam or midazolam to effect. The use of multiple drugs is to be discouraged, since it generally increases the level of sedation and the number of complications. Dosing should be individualized rather than averaged or arbitrary. The end point of titration is the patient's verbal acknowledgement of feeling more relaxed and the physical evidence of such relaxation. The "Verrill sign" indicates a level of deep sedation--too deep for most cases of conscious sedation in the office setting. I strongly oppose the routine use of narcotics for office sedation. Monitoring of vital signs before, during, and after surgery ensures the safety of the consciously sedated patient. The use of a pulse oximeter is an evolving standard in general anesthesia and may eventually prove important for patients receiving conscious sedation in the office setting.