Sedation levels can range from light to deep during the same procedure. The drugs used during sedation have an hypnotic effect as well as, although mild, an analgesic effect.
In light sedation, the drugs used allow the patient to be in a state of relaxation, mainly controlling anxiety. In the vast majority of situations, the level of consciousness is maintained or there is a slight drowsiness, being easily aroused. In this case, the patient is able to respond to external stimuli, both tactile and verbal.
In moderate sedation the level of consciousness becomes more depressed. The response to verbal and tactile stimuli is almost nil, and the patient is arousable with mild painful stimuli.
In relation to deep sedation, consciousness is depressed and the patient only awakens under painful or repeated stimuli.
At all these levels, patients maintain spontaneous ventilation, without the need for any airway assistance. Most of the time, only a nasal cannula is placed to administer supplemental oxygen.
Monitoring vital signs is crucial. These sedation levels can fluctuate between each other. In order to always maintain safety, the presence of an anesthesiologist as well as a nurse with competence in Anesthesiology is essential.
In general anesthesia the patient is placed in a state of induced coma. In this situation, spontaneous ventilation is not possible and it is necessary to use an airway aid with subsequent mechanical ventilation. Here patients do not respond to any stimulus. General anesthesia is necessary for more invasive and very painful procedures, which also involve complete immobilization of the patient.
For most dental procedures, performed in an office environment, the desired level of sedation is light to moderate in which consciousness is maintained or quickly regained.
The analgesic effect of the drugs used is residual, and it is extremely important that an analgesic supplement is provided. In other words, the fact that the patient is under sedation does not exclude the need for local anesthesia.
Both sedation and general anesthesia have associated risks. These are more frequent in general anesthesia than in sedation and are, in short, respiratory complications, regurgitation with subsequent aspiration pneumonia, temporary nerve injuries associated with longer procedures and an allergic reaction to the drugs administered.
In order to reduce associated complications to a minimum, a pre-anesthetic assessment questionnaire is prepared, with subsequent validation by the anesthesiologist. In addition to this assessment, the following recommendations are made so that the procedure can be carried out safely.
Anesthetic drugs are currently highly safe. With compliance with all recommendations as well as adequate and constant surveillance by the anesthetic team, the risk of complications is almost zero. We can therefore conclude that it is safe to perform these dental procedures under sedation, allowing the patient greater comfort.