IV Sedation Question

[Kimmadsim]

Asking as a nurse and mother:

My daughter had dental extractions under IV sedation in office. I thought after Versed she would forget everything but she recalls the Dr conversation, tugging, sawing, felt the stitches, remembers her shoes falling off four times , essentially everything and the pain.

Her IV site looked normal. She doesn’t take any meds except birth control . She is a college student ( which Dr afterwards says it’s pretty typical that college students require a lot of meds assuming alcohol related?) 

I recall Novocaine x 5 injections  failing when she was 18 yrs old getting a cavity filled.

Thoughts? Anxiety related or a physical cause?

[MunoRN, RN]

The amnesic effects of Versed tend to vary from patient to patient, but they also are less likely to occur when true moderate sedation is used, and for the most part dental offices are limited to providing moderate sedation (the patient still rouses easily to minor stimuli).  

"Sawing"?

Why did someone keep putting her shoes back on?

[Kimmadsim]

Oh my! I guess the shoe thing sounds weird without explaining she was wearing Ugg slippers. Sawing was “ cutting the teeth with a dental saw or instrument” She also Remembers a nurse wiping her cheeks from tears and “ patting her head” to calm her. 

[JBMmom, MSN, NP]

As Muno mentioned, like all drugs the effects can vary from person to person. As long as she has no negative effects, I wouldn't worry about it. There are cases where people have had recall through surgery under anesthesia. A little presumptuous of the MD to assume that she drinks alcohol just because she's a college student, though. 

[iluvivt, BSN, RN]

I just had this done too and had Versed and Fentanyl ( moderate sedation) .The only thing I remember is they had this oxygen bar resting on the bridge of my nose and it was hurting me so I remember telling them it was hurting me. It  was very heavy to be resting on the bridge of someone's nose.I have never seen any Oxygen delivery system like that before.My nose hurt for 10 days post-op!

[londonflo]

On 11/21/2021 at 9:48 PM, Kimmadsim said:

Thoughts? Anxiety related or a physical cause?

dreams

[Daisy4RN]

Could be either anxiety or a physical cause or both. Did she seem overly anxious going into the procedure. I know someone who won’t step into a Dental office for anything without a anti-anxiety med. I agree with others that it doesn’t seem anything to worry about at this point unless she is still anxious for future visits. If she is you could talk to MD (or she could herself if over 18) and try to get to the bottom of it. 
Not that it is a big deal but I am also unclear why someone would keep putting her shoes/slippers back on. Techs are usually sterile/clean and I wouldn’t want them picking up dirty shoes. Maybe it was upsetting her for some reason, IDK. 

On 11/25/2021 at 7:20 PM, iluvivt said:

have never seen any Oxygen delivery system like that before.My nose hurt for 10 days post-op!

I have never seen that either. 10 days, ouch!

[mmc51264, BSN, MSN, RN]

Some people react differently to different meds. We use a long-acting nerve block for some surgeries (ortho related) some people get the 96 hour advantage, and others get less than 8 hours of relief. 

As for dental, so far, my kids have been OK w/nitrous, and my oldest had some oral surgery with an oral surgeon and I believe he used propofol. 

[Rodman]

Are you sure she had Versed?  Propofol is very often used and lacks the significant amnestic effects of barbiturates and benzodiazepines

[Guest219794]

On 12/5/2021 at 1:36 PM, Rodman said:

Are you sure she had Versed?  Propofol is very often used and lacks the significant amnestic effects of barbiturates and benzodiazepines

IME, Milk of Amnesia results in people saying "OK, I'm ready.  Let's do this." about 3 minutes after we reduce their shoulder.

 

[MixedVenousSat]

On 12/5/2021 at 1:36 PM, Rodman said:

Are you sure she had Versed?  Propofol is very often used and lacks the significant amnestic effects of barbiturates and benzodiazepines

If they had used propofol, they would have likely intubated her (or at the very least, had an LMA) and needed a fully qualified anesthesia provider at the operation. Propofol (at comparative sedative doses) also has similar amnestic effects as Versed, providing similar amnestic relief (Miner, et. al 2005 & Veselis, et al 1997).

A dental or oral surgeon office, without a dedicated anesthesia provider, cannot administer full general anesthesia (full unconsciousness and loss of ventilatory drive). This surgeon likely chose to opt for moderate sedation, AKA 'twilight sedation', utilizing versed. The patients must be able to follow commands and remain semi-conscious. Unfortunately, there is no guarantee that they will not remember the procedure. It is up to the practitioner administering the anesthetic whether additional medication is necessary. More medication does increase risk of respiratory depression and hypotension, leaning towards deep sedation, which changes the risk profile of the patient immensely. It seems they had a safe outcome, and this was the sort of procedure where full unconsciousness and full amnesia was not necessary.

[Rodman]

On 11/22/2021 at 2:10 AM, MunoRN said:

The amnesic effects of Versed tend to vary from patient to patient, but they also are less likely to occur when true moderate sedation is used, and for the most part dental offices are limited to providing moderate sedation (the patient still rouses easily to minor stimuli).  

"Sawing"?

Why did someone keep putting her shoes back on?

Not true.. .Oral and Maxillofacial surgeons administer deep sedation on a routine basis.  This is with an open airway and most states require two additional trained individuals (assistants)