IV sedation didn't work?!? (midazolam)

[CuriousGeorgie]

Hi everyone! I hope this is in the right place! I'm feeling very frustrated and upset so this is going to be a real rant n' ramble - I apologise in advance for length but there are questions in here somewhere!

I'm 22 and have severe dental and needle phobias after a traumatic experience at a dental hospital when I was little. I last went to the dentist when I was still small enough that my dad could pick me up and carry me in whether I liked it or not! I attempted to visit a dentist recommended to me in April 2014, having had two very obvious holes and increasing sensitivity in an upper molar on each side for some time. He was far from reassuring and I was not happy with the sedation options he was offering, so I saw a different dentist who was much better but had very different ideas to the first dentist about what treatment I needed! I didn't know who to believe so promptly lost confidence in the whole process and gave up. I've now been in virtually constant pain since Christmas due to what turns out to be two severe abscesses in those two upper molars. Luckily my mum found a local private dentist who specialises in nervous patients and sedation and persuaded me to go. He was absolutely amazing and for the first time I left a dental surgery crying out of relief rather than fear! I need two root canals and two fillings (shameful at 22, I know! ) but he was very understanding of my phobias and we decided on a course of action - NO2 and a pre-med first to calm me enough for the IV insertion and then conscious sedation with midazolam. He even made the appointment for a day when he doesn't usually work so I could have whole day if I needed it, I really thought this was my salvation!

I psyched myself up for the appointment this morning, my determination to not be in pain winning out over my sheer terror and I got there! I did get in a bit of a panic in the waiting room so he rushed me in to get the NO2 going and it had absolutely no effect whatsoever. I expected that it wouldn't work brilliantly as I was so anxious, but I have had it successfully before and expected at least a little bit of an effect. All the while I could see and hear him preparing the IV/cannula and got in a complete panic until my heart rate was up to something ridiculous. He asked if he could try and put it in and I still had some of that determination left so I said yes (also should point out that my parents are paying a fortune for this which is definitely influencing my decision making). He didn't use any numbing cream which I am a bit cross about, but I guess he believed the NO2 would work. It took FIVE attempts to get the cannula in - I am very difficult to find a vein in anyway and when he did get one in I was so anxious that my veins were constricting and pushing it out, and squirting blood everywhere including all down my dentist's trousers - each attempt failed and each time he asked to try again I just got more and more panicked, I started hyperventilating and my mum who was with me was increasingly having to hold me down rather than 'hold me'. I cannot stress enough how much this was my absolute worst nightmare come true but all I could think was if I could just get the IV in, the amnesic effect of the midazolam would make me forget about all about it. (I realise this account won't help anyone on here with a needle phobia, I really do apologise!)

Finally it was in, he put the numbing pouches in my mouth and started the first dose of midazolam which had no effect. He topped it up again after a few minutes and asked if I was feeling light-headed or finding it hard to focus on what was around me, I told him the PAT electrical test on his dental lamp was out of date, so no. He topped it up again and at this point I started asking in earnest if he'd put it in. I genuinely believed I hadn't been given anything. With each hit apparently my heart rate would drop for about 15 seconds before shooting back up again, during one of these drops he administered the local anesthetic, I was numb from the pouches so didn't feel it but I was completely aware of what was going on with my heart still pounding through my chest thinking 'oh my god he's doing injections in my mouth! I don't think this is what sedation is supposed to be like!' By this point he said he'd given me as much midazolam as he legally could, that I was not going to be successfully sedated and asked if he could try drilling as I was numbed anyway. I let him so as to try and achieve something out of the experience, he managed to drill out one tooth but was unable to start filing the canals because I was still moving/panicking too much. The other side is a 'hot tooth' which the antibiotics have not helped and it was too painful, he topped up the local anesthetic but this did not help. At this point we both simultaneously said "I can't do this!" and that was that!

I am completely and utterly gutted. I was so ready to have this done and gave it my all. My dentist was very apologetic and sincere that this was not the experience he wanted for me and I don't blame him at all but I am so confused by this whole sedation business! I spent the entire time in a blind panic. At no point did I feel sleepy or calm down at all, my heart rate did not drop and I could not stop moving. I can remember every detail of what happened, including the IV fiasco I was so desperately hoping to forget! There were no sedative, anti-anxyolotic, muscle relaxing or amnesic effects. My dentist suspects I have very fast drug metabolism and as midazolam is short-acting my body was perhaps flushing it out before it had a chance to work, can this be the case? He's referring me to a dental surgery which has a resident anaesthetist who can apparently compensate for this. I have to say since leaving the dentist, I've been feeling really crap - tired, foggy and nauseous - which seems odd as it seemingly didn't work.

Does anyone else, patient or dentist, have any experience of sedation just not working??? I remember being told at one point not to 'fight it', was it me? Apparently large amounts of adrenaline can stop these drugs working but that seems counter-intuitive as anti-anxyolotics have to work on anxious people? I can't find anything online about resistance to midazolam other than in people who have abused benzos which I have not? Will I have the same problem with different drugs if I am metabolising them too fast? And will it still be difficult around the hot tooth even if I am successfully sedated?

If you've got this far thank you so much for reading my ramblings, please feel free to go back to your normal lives now!

Georgie

 

[Angeldove]

For some people, medications will not work unless our bodies calm down. I haven't had any sedation at my dentist (just numbing, but needles don't bother me much - except when the stupid dentist is hitting nerves in my jaw ).

I remember as a child, after breaking my femur and being in the hospital for a few weeks, that they had to remove a bar realigning my lower leg, and they gave me sedation that should have made me groggy and not remember anything of the incident later on.

My body, however, knew exactly what was going on and I was awake for the whole thing, felt all of the pain, and have a full memory of what it was like. It wasn't until after the procedure was over that my body calmed down and I took a long nap.

When fearful our body will fight hard enough to keep us in "fight or flight" mode. That's unfortunate for those who need to be sedated to get dental work done.

Perhaps talking to a therapist about your needs would help a bit? Perhaps the dentist starting the sedation in a more comforting area (private office, etc?) would be less stressful. Some dentists are specialized and can come to your home for treatment, which might be more comforting to you.

I'm very sorry to hear that you've gone through this. Hubby, since starting my journey, keeps pressuring me to try sedation since my heart is usually pounding throughout a procedure, but I've never tried it since I'm too scared of what it might do to my body (meds kind of scare me - I had a BAD experience with antibiotics so it kind of turned me off to the whole medicine thing). I can't imagine how difficult it makes things to those who need something to calm them, but the meds don't work. I hope you can really get this figured out so you can improve your mouth health and not be in pain anymore

 

[gentledental]

I'm sorry to hear about your latest traumatic experience and to hear your story is very unusual. We have treated many patients before and although we do have the odd patient who may have panic attacks during the cannulation stage, there hasn't been any patients we couldn't sedate and treat. If you are panicky with the cannulation stage then you can get a prescription of some diazepam to take a day before your appointment and that should hopefully calm you down. Everyone behaves differently to midazolam (some people need more and some less) but we have never had a single patient we couldn't sedate once the cannula was in place. I'm very sorry that you went through that ordeal but hopefully you will find something that works for you. My only suggestion is to plan to have a trial sedation first just so you know what the sedation is like before contemplating getting the dentistry done.

Good luck!

 

[geos]

When I was a kid I had a similar situation then Angeldove. It was also to remove a bar realigning my lower leg and I also couldn't get sedated. In my case I went through the operation successfully, which helped not loosing too much confidence.

Later in life, I had other operations where I needed to get sedated and it worked perfectly.

One thing that could help would be to have pre-med to calm you that you either take at home or the second you get in the waiting room.

The medication stays in your system for some time, so it's a bit normal to have those feelings afterwards.

 

[shamrockerin]

I have never had IV sedation before, so I cannot comment on that specifically. However, I have tried various oral sedatives, such as Valium, and also nitrous oxide, and they've had no effect on me whatsoever.

I can relate to your frustration; whenever I've tried to confide in people about my dental phobia they say "Oh just get the laughing gas and then you won't care". I've tried it a number of times, and even when the dentist turned it up really high, I wasn't getting any effect from it. They even put the nitrous mask on me while I was in labor this past January and of course it did nothing.

I've also tried Valium, and one time I took 7 pills in the 12 hours leading up to an appointment. That's quite alot, but I didn't even feel it.