Medically Complex Patients
Intravenous (IV) sedation is an advanced technique involving administering sedatives and analgesics intravenously to produce a relaxed, calm state in patients undergoing dental procedures. IV sedation enables safe dental care for patients whose medical conditions make standard local anesthesia unsafe or ineffective.
This case study focuses on a medically complex patient for whom IV sedation was essential to facilitating necessary dental treatment without compromising the patient’s health.
TL is a 68-year-old retired accountant with a history of type 1 diabetes, hypertension, cardiovascular disease, and atrial fibrillation. His medication regimen includes insulin, metformin, lisinopril, metoprolol, and warfarin. TL presented to our dental practice with extensive decay, abscesses, and missing teeth that made eating and maintaining proper nutrition difficult. This negatively impacted his diabetic control. However, TL’s comorbidities posed dental risks including warfarin interfering with dental bleeding, stress inducing cortisol altering TL’s blood pressure and glucose levels possibly inducing cardiac complications.
Coordination of Care
Our dental team held a care conference with TL’s cardiologist, primary care physician, and endocrinologist to formulate a safe, effective treatment plan. We discussed medication adjustments, vitals monitoring, maintaining glucose levels, anticoagulation protocols, and emergency contingencies. This cross-disciplinary collaboration allowed each specialty to voice concerns, identify risks, and align on interventions to mitigate issues. The consensus was that IV sedation performed under close monitoring would enable delivering necessary dental care while preventing TL’s complex medical conditions from worsening.
IV Sedation Procedure
On the day of the procedure, TL’s home medications were held per protocol. After placement of IV access, oxygen, and ECG leads, TL was administered sedation medications IV while continually monitoring the oxygen saturation, blood pressure, heart rhythm, respiration, and glucose levels. The 3-hour procedure including extractions and restorations proceeded uneventfully. With precise medication titration, TL remained comfortable and stable throughout.
TL recovered smoothly after the dental procedures. Within a week, he reported significantly improved ability to eat, resulting in better strength and diabetic control. At follow-up visits, TL’s cardiologist and endocrinologist were pleased with his continued progress. Ongoing dental health is important for TL’s treatment of his chronic medical conditions.
This case demonstrates the value of IV sedation to enable patients with complex co-morbidities to safely access needed dental care. Close collaboration between dental and medical teams, along with meticulous monitoring during the procedure, allowed a potentially hazardous situation to proceed predictably. IV sedation expanded the options for this high-risk patient. Our team approach produced the optimal outcome of restored dental function and improved systemic health.