why so many different drugs?
There are quite a few other drugs that can be used for IV sedation. But in practical terms, most of the time a single benzodiazepine, usually midazolam, is used. This is especially true in the UK, where polydrug use is discouraged (even though it is not illegal). A typical IV session takes up to 1 1/2 hours. If it takes longer, it’s done in multiple visits, or depending on the case, under General Anaesthesia.
In the U.S., the situation is slightly more complex. Polydrug use is much more common, possibly because IV sedation is taught at a high level. This encourages the use of polypharmacy (multiple drugs). Also, there appears to be a liking for long IV sessions, which require the use of polypharmacy. Long IV sessions may be driven by consumer demand, or maybe it’s a training issue.
Many IV specialists in the United States are opposed to the use of opioids for sedation, but there is a habit of using them ingrained in most practitioners. However, things appear to be changing as new dentists are coming through.
The general consensus among the leading experts in the field of dental sedation today is: the fewer medications are used, the safer the treatment tends to be (and the easier it is to track any potential problems). Usually, this means one medication only. Midazolam tends to be the drug of choice.
