Intravenous sedation (IV) entails the administration of sedative agents directly into the vascular compartment. The use of IV sedation in a dental office requires additional advanced training beyond the curriculum of dental schools. The most common parenteral sedation technique in the general dental office involves the use of a benzodiazepine (e.g., diazepam or midazolam) alone or in combination with an opioid (e.g., fentanyl or demerol). Because of potential additional risks, other techniques such inhalation should be considered first.
A major advantage of IV sedation is that it allows for titration. It provides for rapid onset (20-25 seconds) and shorter recovery compared to oral sedation, but longer than nitrous oxide/oxygen. In an emergency, it provides ready access to a vein. Finally, patients will often have vague or no recollection of the procedure or the length of time they were under treatment.
The need for access to a peripheral vein and the anticipated pain may alarm the severely anxious patient. The use of nitrous oxide/oxygen as a pre-sedative may prove useful in this situation. A potential concern is local complications at the injection site. Other disadvantages include the need for additional training on the part of the clinician and the need for a responsible adult escort for the patient.
The principal indication for the use of intravenous sedation is the management of moderate to severe anxiety, where oral and/or nitrous oxide/oxygen may not be effective. It is also indicated when longer, more involved procedures are planned such as impacted third molar extractions or when amnesia is desired.
Intravenous sedation should not be administered by unqualified, i.e., untrained providers. It is also contraindicated during pregnancy and the extremely obese - due to difficulty to maintain patent airways or access to the airways in case of an emergency.