Another IV sedation Thread, but stay with me...

[Jackyv]

Hey all,

This is a big one so, you know, stick with me.

I'm an emetaphobe and that phobia has spread into a full fledged-fear of panic attacks themselves (because I'm worried I'll get sick). The irony, of course, is I haven't been actually sick in over thirty years. And I've never been sick from panic ever. Logic doesn't really get much say here though.

Anyway, one big trigger for me is feeling out of control, and what confers less control than being laid back with your mouth open and unable to escape? Yeah, so that's where my dental phobia comes into play and the particular brand of dental phobia I have. I sit in the chair, I panic, I fixate on my stomach, I run away and I'm safe again. It's so extreme that I can barely sit still for a 30 second examination.

I've been scheduled for IV sedation (Midazolam only - UK here) for an extraction next week and I am SO scared about the side effects of Midazolam IV, on top of actually being afraid of how it will feel, feeling nervous and worried about fainting with the cannula, I'm worried it won't sedate me enough and I'll feel panicked and awful and be aware the whole time, and the many other usual anxieties about this procedure. The only reason I haven't cancelled is the insane agony I've been in with this tooth. It's calmed down pain-wise now, but I know it'll be back if I don't find a way to go through with this.

I'm also a little nervous the Midazolam won't work because I take Diazepam PRN (my average daily dose works out to about 2-2.5mgs, but I haven't ever taken it daily.) My last appointment, prior to the suggestion of IV sedation, I took 15mgs, and whilst I was calm and chatty, and a little fuzzy, I was very aware and not able to suspend the anxiety nearly enough to have the tooth pulled.

The sedation appointment is scheduled first thing in the morning, but I don't know if I should eat or not eat to ensure I don't feel sick from the Midazolam, I don't know if I should ask about numbing cream for the cannula so I don't feel it (is that a thing?), I'm just so worried and apprehensive, and really just want to hear some positive stories, some affirmations, and if you've been on Benzos and still had a nice amnesic experience with Midazolam?

Please help...

 

[feelingbetter]

Hi Jackyv

I had IV for an extraction in the UK last week so it's fresh in my mind and will try to answer and reassure you as best I can. I had 10mg Diazepam the night before and still felt the effects for the early morning appointment so while not looking forward to it, I was much calmer than in the weeks leading up.
You should ask your dentist about eating. I was asked not to eat for 2 hours beforehand. So 2.5 hours beforehand I had a slice of bread and butter to line my stomach and a large smoothie for blood sugar. I wasn't allowed to eat for 4 hours afterwards but that didn't matter as I felt no hunger. At no point did I feel any nausea - that just didn't come into it.
I am not needle-phobic so I had the cannula without numbing cream and it was just a mild sting, like a LA. Maybe you can ask for cream.
My main worry was being aware/feeling pain but I was wonderfully out of it. From being asked to move back in the chair to 'waking up' to gauze being put in I was unaware. Really it was wonderful, as others described to me but I kept thinking 'yes, but, for me it might be different...' The worst was the apprehension and on the day, the idiot driver who almost backed into us on the way to the dentist.
Ask me anything else you like - but really, I can assure you that IV is the way forward

 

[letsconnect]

I can’t really add anything to what @feelingbetter has already said! Just an interesting side note - midazolam is an anti-emetic, that is, it suppresses feelings of nausea and vomiting, so it’s a wonderful drug if you‘re dealing with emetophobia

Wishing you all the best for next week

 

[Jackyv]

Thank you both so much.

Hearing that positive story really has helped. I’m just so damn anxious (and tired of feeling anxious), so battling the emotion away with logic is a real challenge.

@feelingbetter
How did you feel after leaving the dentist? I’m not super fond of being a car passenger either but I’m having to be driven home (for 40 mins), but I’m sort of hoping the midazolam will be in my system enough to keep me calm for that journey back.

Did you also find you didn’t really remember the treatment at all?

@letsconnect
I didn’t realise it was an anti emetic! I’d only read that nausea and vomiting were side effects sometimes seen in midazolam (more commonly in oral form, but any risk of it is scary for an emetophobe, ofc). Thanks for the information

 

[feelingbetter]

Absolutely nothing about the treatment from after the cannula going in and being asked to move back to being asked to open my mouth for gauze insertion and being given some painkillers. It was great. The best dentist experience.

I was unusually calm on the 30 minute drive home (I don't like driving either). Husband missed a turn so we had to go a longer way and I remember thinking 'am I annoyed? Shall I say anything? Well actually am I bothered? I think I'll let it go.'

You mention control. That was my problem, I realised. The feeling vulnerable at the dentist's and also having to let people look after me after the treatment. So I did a lot of self-examination beforehand. I realised the terror was stemming from that. I agree logic flies in the face of fear (that's another one for me - I can't fly no matter how much people reassure me about plane safety). I had feared panicking at the last moment but actually I was calmer before the treatment than I had been several weeks beforehand because I had looked into the fear.

 

[Jackyv]

Well, I'm still VERY anxious that my long term (low dose though) Diazepam will mean the Midazolam won't work. If it doesn't, I'm really not sure what I'll do.

I don't suppose anyone here is on Diazepam semi-regularly and has had Midaz IV?

Also, I just bought some Ametop cream for the cannula so hopefully I won't feel that at all!

 

[feelingbetter]

I think a chat with your dentist about the Diazepam and Midozalam would go a long way to reassuring you. I would guess you wouldn't be the first to have the latter on top of the former.

 

[JBH316]

I wish they could bottle up Midazolam and let me take it home! I had to have a surgery last year, and that's when I learned how terrified I was at the thought of a general anaesthetic. I was bawling my eyes out every day for about 2 months leading up to it. The anaesthetist gave me some Midazolam straight in the mouth and I ended up without a care in the world. I had no idea dentists used it too! I hope it works as well for you as it did for me because the change in me that day was nothing short of miraculous lol

 

[Jackyv]

I think a chat with your dentist about the Diazepam and Midozalam would go a long way to reassuring you. I would guess you wouldn't be the first to have the latter on top of the former.

Yeah I did ask, she kinda said if I have some tolerance it may mean they need more Midaz or it may not work fully, but that they really couldn’t say.

I then asked a Doctor who said that Midazolam is much more potent and whilst I may have some tolerance, it’s unlikely to make a huge difference.

I still feel like I’m getting conflicting information and I can’t find much online - I’m also wavering between acceptance of the procedure with a mild sort of anxious calm combo, and total panic that my anxiety will trigger my emetophobia and panic cycle and I’ll not be able to go through with it.

 

[Jackyv]

I wish they could bottle up Midazolam and let me take it home! I had to have a surgery last year, and that's when I learned how terrified I was at the thought of a general anaesthetic. I was bawling my eyes out every day for about 2 months leading up to it. The anaesthetist gave me some Midazolam straight in the mouth and I ended up without a care in the world. I had no idea dentists used it too! I hope it works as well for you as it did for me because the change in me that day was nothing short of miraculous lol

Oh wow, it worked that strong orally? Do you remember much or did it also have the amnesia effects orally too?

 

[feelingbetter]

@Jackyv I relate to your descriptions of contrasting feelings. All I can say is three weeks beforehand my fear of a panic attack on the day was only serving to reinforce my fear at the time. The 'what ifs' aren't real. They only add to the fear. As was proved on the day, when, after 10mg diazepam the night before, I was in a 'not looking forward to this but let's get it over with' mood, and fairly calm.

Also. the Midaz is much stronger than the Diaz and if you are still reacting they can top it up. I believe that's the beauty of it - it can be controlled very precisely.

 

[Jackyv]

@Jackyv I relate to your descriptions of contrasting feelings. All I can say is three weeks beforehand my fear of a panic attack on the day was only serving to reinforce my fear at the time. The 'what ifs' aren't real. They only add to the fear. As was proved on the day, when, after 10mg diazepam the night before, I was in a 'not looking forward to this but let's get it over with' mood, and fairly calm.

Also. the Midaz is much stronger than the Diaz and if you are still reacting they can top it up. I believe that's the beauty of it - it can be controlled very precisely.

I really want to take Diazepam the night before, but they've told me not to for 24 hours (I guess to increase the ceiling on the amount of Midazolam they can put into me.

I'm a little bit wary about how it'll feel and sceptical it'll make me suddenly feel so chill, but maybe that's just because Diazepam just sort of takes the edge of slightly, and that's my only experience with any sort of Benzo - The only other anaesthetic I've ever had was Nitrous Oxide in Australia, and it sort of made me unable to act rather than chilling me out etc. It got the job done, but I wouldn't say I found it a pleasant experience and I remembered the whole thing. (Obviously anterograde amnesia is far less common with NO)

I suppose I'm dreading the dread. The nervous anxiety in the car on the way up, sitting in the waiting room, the time I'm sat in the chair waiting for the Midaz to kick in.

I really, REALLY hope I get the full amnesic effects of it...

Thank you so much for your responses, it is helping a lot.

 

[Jackyv]

Two hours until it’s time. Still more anxious about being a passenger in the car on the way home after. Very odd