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Old 03-25-2018, 05:37 PM   #1
brysdad
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Default Conscious Sedation

Going in for my first round of dental work in many years this week. Terrified is an understatement. Iím doing conscious sedation but donít really know what to expect. Supposed to be in the chair around five hours this round. Anyone have history with this kind of sedation? Set my mind at ease.
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Old 03-25-2018, 05:40 PM   #2
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Might wanna put your phone on record to see what perverse things you say.
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Old 03-25-2018, 05:42 PM   #3
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As one who is terrified of dentists I think it's great. It takes a bunch to put me under but when I wake up it's all over.
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Old 03-25-2018, 05:46 PM   #4
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If it’s the same type of conscious sedation as steroid injections into the discs in your back, you will be fine. You’re aware, but out of it, and will only feel some slight pressures in the work area. I’ve never been high as a kite, but if I had to take a wild guess, this is about as close as you can get. Relax and enjoy the ride.
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Old 03-25-2018, 05:46 PM   #5
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It's not just the procedure it's also the recovery. Dentist are misleading when it comes to the pain they indict.
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Old 03-25-2018, 05:46 PM   #6
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Originally Posted by Geezy Rider View Post
As one who is terrified of dentists I think it's great. It takes a bunch to put me under but when I wake up it's all over.
Is that with IV sedation or just the pill? I think mine is just a pill of some sort. I have to pick up scripts in the morning.
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Old 03-25-2018, 05:47 PM   #7
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Originally Posted by brysdad View Post
Going in for my first round of dental work in many years this week. Terrified is an understatement. Iím doing conscious sedation but donít really know what to expect. Supposed to be in the chair around five hours this round. Anyone have history with this kind of sedation? Set my mind at ease.


Basically you will be awake (though groggy) and able to communicate but then won't remember afterward. They usually use a combination of Fentanyl and Versed. Versed has a weird property where it erases short term memory.
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Old 03-25-2018, 05:47 PM   #8
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Might wanna put your phone on record to see what perverse things you say.
Or to record what they say about you
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Old 03-25-2018, 06:02 PM   #9
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You may want to make sure beforehand that they are conducting ETCO2 monitoring while you are under sedation. If they are just monitoring your O2 levels then you need to know that ahead of time. Especially for a Surgery as long as you have indicated. If done properly they will place an ETCO2 cannula on you. This will monitor CO2 levels and deliver oxygen at the same time. They will place a finger probe on you to check your O2 levels. Make the phone call and ask if they do ETCO2 monitoring and what type of a machine it is. If they tell you it is a finger probe then they are not monitoring you.......I sell in to Hospitals, Surgery Centers, and Dental offices. Not all Dental locations monitor. Just providing additional info.
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Old 03-25-2018, 06:07 PM   #10
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Man up and tell the doc to give you a local. I've had so much done lately it's becoming routine. Getting a cracked molar pulled Tuesday.
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Old 03-25-2018, 06:10 PM   #11
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Originally Posted by sunsethunter View Post
Basically you will be awake (though groggy) and able to communicate but then won't remember afterward. They usually use a combination of Fentanyl and Versed. Versed has a weird property where it erases short term memory.
I had to laugh and comment on this.....I introduced as a biotech sales person Versed when it was first introduced. What a great drug.....they can laugh and call you all kinds of names and you won't remember a thing! Of course, during the initial marketing of the drug there were too many that dosed it like Valium and produced a LOT of respiratory problems..."lot's of Ambu Bags used."

"I'd rather have a VERY good "gas passer" than surgeon in most situations whether a DDS or MD/DO.

Just make sure they give you adequate post op Pain Meds....NO reason to suffer until you heal. Good Luck and it will all be fine......
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Old 03-25-2018, 10:44 PM   #12
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Your scripts are for pain meds. Oh yeah, you're going to need them.
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Old 03-25-2018, 10:50 PM   #13
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5 hrs?!!...

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Old 03-26-2018, 12:11 AM   #14
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I went in for oral surgery and had all my top teeth taken out at one time. Surgeon asked me if I wanted to be awake or asleep. I said knock me out doc. Woke up a few hours later and a little groggy. Wife drove me home and a few Tylenols all was fine. Dentures fit fine after all the swelling went down. Best decision I have could have made.
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Old 03-26-2018, 12:25 AM   #15
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My wife has to have Ativan before any significant dental procedure.
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Old 03-26-2018, 12:27 AM   #16
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I went in for oral surgery and had all my top teeth taken out at one time. Surgeon asked me if I wanted to be awake or asleep. I said knock me out doc. Woke up a few hours later and a little groggy. Wife drove me home and a few Tylenols all was fine. Dentures fit fine after all the swelling went down. Best decision I have could have made.


I did the same, except with a local shot. Once all teeth were yanked they slammed the upper plate in and told me not to take it out until a follow up visit the next day..... good times

And yes, best decision Iíve made concerning my teeth.
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Old 03-26-2018, 05:43 AM   #17
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Is that with IV sedation or just the pill? I think mine is just a pill of some sort. I have to pick up scripts in the morning.
It's the pill.
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Old 03-26-2018, 06:37 AM   #18
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Originally Posted by sunsethunter View Post
Basically you will be awake (though groggy) and able to communicate but then won't remember afterward. They usually use a combination of Fentanyl and Versed. Versed has a weird property where it erases short term memory.
In a nutshell

Most people "think" they were asleep but the amniotic effect of Versed is the cause of that

Some people will carry on conversations the whole time and never remember it. Come in next time and swear they were put completely out

Byron has a good point about CO2 levels and length of your procedure
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Old 03-26-2018, 06:39 AM   #19
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I’ve got to be there at 8 this morning so I’ll figure out more about what and how this is all going down. I appreciate the input so far.
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Old 03-26-2018, 07:18 AM   #20
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Good luck.
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Old 03-26-2018, 07:39 AM   #21
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Had a hypnotherapist friend who was able to put herself under without any drugs while getting dental work done. I've never been able to get myself into that much of a trance.
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Old 03-26-2018, 09:10 AM   #22
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Interesting info from some of you guys...

I do conscious sedation at work for procedures and work at a hospital. Its a big, well known hospital and we dont do any type of end tidal co2 monitoring. Id be more interested in who is doing the sedation and monitoring. Is it a nurse or an anesthesiologist?
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Old 03-26-2018, 09:50 AM   #23
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Gee, a combination of Fentenal and Versed, at least if you die you can rest easy knowing you imitated Michael Jackson!!!!
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Old 03-26-2018, 12:04 PM   #24
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Gee, a combination of Fentenal and Versed, at least if you die you can rest easy knowing you imitated Michael Jackson!!!!
Michael Jackson was into Propofol same stuff that they give you when you have a Colonoscopy.
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Old 03-26-2018, 12:13 PM   #25
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Some of y’all are less than helpful ��! Looks like 1mg of Ativan before I go in and then another pill that starts with V before they start. Sound like enough to folks in the know? Said the first hour is to get me good and sedated. Sure hurt to pay for it this morning! Hopefully that was the most painful part.
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Old 03-26-2018, 12:42 PM   #26
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Conscious sedation? I do that every weekend.
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Old 03-26-2018, 01:58 PM   #27
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Quote:
Originally Posted by 8mpg View Post
Interesting info from some of you guys...

I do conscious sedation at work for procedures and work at a hospital. Its a big, well known hospital and we dont do any type of end tidal co2 monitoring. Id be more interested in who is doing the sedation and monitoring. Is it a nurse or an anesthesiologist?
I do conscious sedation at least a couple of times per week in the ER. ETCO2 is mandatory when we do. 1 RT, 2 MDs and 1 RN are also required to be present.... MD pushes the sedation meds, RT monitors airway and RN monitors vital signs.

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Last edited by nursejenn; 03-26-2018 at 02:00 PM.
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Old 03-26-2018, 03:59 PM   #28
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Went in a few years ago for about 8 hours of dental work. Took a pill about 8:45 AM. Nurse came in about 9:15 and asked how I was doing. Nothing, so another pill and put on the first ďBourneĒ movie. Woke up in my bed the next morning not remembering one thing that had happened in the past 22 hours.

Fast forward a couple of weeks and Iím back in for about 3 hours worth of work. Nurse asks me what I want to put on the TV. I tell her to put Bourne back in as I donít remember watching it the first time. She just laughed and told me that I had watched all three!

Never again. Iím surprised I woke up with both of my kidneys.


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Old 03-26-2018, 04:04 PM   #29
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What kind of dental work are you getting done for 5 hours?? That sounds miserable. I had a root canal done a couple of weeks ago, local anesthetic and about an hour later, I was good to go (but couldn’t move the left side of my face haha)
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Old 03-26-2018, 06:03 PM   #30
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Quote:
Originally Posted by 8mpg View Post
Interesting info from some of you guys...

I do conscious sedation at work for procedures and work at a hospital. Its a big, well known hospital and we dont do any type of end tidal co2 monitoring. Id be more interested in who is doing the sedation and monitoring. Is it a nurse or an anesthesiologist?
Yikes!!!! Which department do you work in? Years ago I used to find ďno monitoringĒ in a location or two in Hospitals. Found one in Austin. Endoscopy Dept.....however, all of the other departments were using ETCO2 cannulas. Then, if you visit an off-site Endoscopy Center I do not know of any that do not monitor. Most of the surgeries are 20-25 minutes. If someone is pushing Anesthesia Meds then the Patient should be monitored. Dental locations are less motivated to do it due to costs. However, I sell to a bunch of Oral Maxillofacial locations that monitor during each procedure. Nurse Jen could chime in on this more......but Respiratory Failure can occur due to the CO2 levels being too high. Oxygen levels may look fine and then failure occurs rapidly. It occurs because no one was watching the CO2 levels. Then they have to bag the Patient. I am not a Doctor but I did stay at a Holiday Inn once.....only once.
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Old 03-26-2018, 06:14 PM   #31
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What kind of dental work are you getting done for 5 hours?? That sounds miserable. I had a root canal done a couple of weeks ago, local anesthetic and about an hour later, I was good to go (but couldnít move the left side of my face haha)
Two root canals and some fillings. Doesnít sound like the full five hours will be ďin the chairĒ. Yíall are kind of freaking me out! I was looking for folks who have had good experiences with sedation. Not really the whole youíre probably gonna die stuff!
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Old 03-26-2018, 06:26 PM   #32
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Two root canals and some fillings. Doesnít sound like the full five hours will be ďin the chairĒ. Yíall are kind of freaking me out! I was looking for folks who have had good experiences with sedation. Not really the whole youíre probably gonna die stuff!


I had the pill when I had all 4 wisdom teeth removed. They said it wouldnít make me fall asleep but that I wouldnít remember any of it. They were right. I gotta wonder though, just because I didnít remember does that mean it didnít hurt?!
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Old 03-26-2018, 06:33 PM   #33
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Nurse Jen could chime in on this more......but Respiratory Failure can occur due to the CO2 levels being too high. Oxygen levels may look fine and then failure occurs rapidly. It occurs because no one was watching the CO2 levels. Then they have to bag the Patient. I am not a Doctor but I did stay at a Holiday Inn once.....only once.
Ok, let me break it down best I can. In a normal (unsedated) person, increasing CO2 levels cause breathing. CO2 level goes up, you exhale and inhale (isn't it kind of amazing what your body does without you even thinking about it?). When you add sedatives to the mix, they actually depress the receptors that you to breathe (or breathe more/faster) when your CO2 rises. When that response is blocked (due to sedation/too much sedation), the person doesn't breathe in response to increasing CO2 and hence respiratory failure. This is why we monitor ETCO2 levels in moderate/conscious sedation rather than SPO2 because the ETCO2 is an earlier and better indicator of respiratory failure. ETCO2 is measured with every expiration of the patient whereas SPO2 is measured peripherally (like on a finger) and takes longer to show a problem on a monitor...

Not everyone has a problem with moderate sedation. Working in a trauma ER, I've been involved in ALOT sedations over the past 2 1/2 years and only once has RT had to bag one of my patients because she stopped breathing...


Now as for my personal experience with it... I had an emergent endoscopy this past July. I learned that I am a lightweight when it comes to sedation meds. When I woke up, the anesthesiologist told me I was out for almost an hour (for a 10 minute procedure) and they had to intubate me until I woke up enough.

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Old 03-26-2018, 06:37 PM   #34
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Two root canals and some fillings. Doesnít sound like the full five hours will be ďin the chairĒ. Yíall are kind of freaking me out! I was looking for folks who have had good experiences with sedation. Not really the whole youíre probably gonna die stuff!
LOL....You will be fine. No need to freak out. It will not hurt to know if they do ETCO2 monitoring though. The people who have not had good experiences are not here to ask. Does that make sense? Believe me, if I have to go in for a surgery I will be way more freaked out than you. I will ask them if they have this machine, that machine, which cannula, who is giving the sedation, are they qualified.....blah, blah, blah. You will be happy it is all done and will not remember much of it.
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Old 03-26-2018, 07:12 PM   #35
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Yikes!!!! Which department do you work in? Years ago I used to find ďno monitoringĒ in a location or two in Hospitals. Found one in Austin. Endoscopy Dept.....however, all of the other departments were using ETCO2 cannulas. Then, if you visit an off-site Endoscopy Center I do not know of any that do not monitor. Most of the surgeries are 20-25 minutes. If someone is pushing Anesthesia Meds then the Patient should be monitored. Dental locations are less motivated to do it due to costs. However, I sell to a bunch of Oral Maxillofacial locations that monitor during each procedure. Nurse Jen could chime in on this more......but Respiratory Failure can occur due to the CO2 levels being too high. Oxygen levels may look fine and then failure occurs rapidly. It occurs because no one was watching the CO2 levels. Then they have to bag the Patient. I am not a Doctor but I did stay at a Holiday Inn once.....only once.
Oh, I know why we monitor it.. We do in lots of neuro patients in the ICU. I occasionally work in a procedural area in our hospital. If a case is longer, we will usually draw a gas. We are surrounded by anesthesia if something were to happen and the good old fail safe is bagging a patient. The ER I used to work in didnt do end tidal CO2 either, but again, in the ER, the MD can intubate if there were an emergency. If our case run over an hour, we are usually checking a blood gas.
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Old 03-26-2018, 09:00 PM   #36
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Iím a dentist and consciously sedate patients on a regular basis. End tidal CO2 monitoring is becoming the trend in our world of conscious sedation. The tough thing about oral sedation is once the patient takes it you have virtually no control. We do however have a reversal agent for the most common drugs we use to sedate patients. Thankfully Iíve never had to use it. Also, everyone is so different as to how these meds affect them. Thorough medical history and patient interview is critical. Also, I look at the patients throat, listen to their lungs, do they have sleep apnea, etc? When every it is done correctly itís very safe and effective. I usually mix a couple drugs together and sometimes even add nitrous oxide to the mix. Thatís almost as good as IV sedation. Different drugs we use have different onsets and last different lengths. The length of the procedure depends on what we sedate with. For instance, versed is quit and potent, but doesnít last long at all. My most common combination is Valium and halcion. Patients typically do excellent and experience amnesia so they donít remember the details of the procedure. Iím sure you will do fine! Best of luck!


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Old 03-26-2018, 09:15 PM   #37
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5 hours! just give me a bullet
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Old 03-26-2018, 09:41 PM   #38
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Oh, I know why we monitor it.. We do in lots of neuro patients in the ICU. I occasionally work in a procedural area in our hospital. If a case is longer, we will usually draw a gas. We are surrounded by anesthesia if something were to happen and the good old fail safe is bagging a patient. The ER I used to work in didnt do end tidal CO2 either, but again, in the ER, the MD can intubate if there were an emergency. If our case run over an hour, we are usually checking a blood gas.
My apologies.....I did not mean to suggest you personally did not know why monitoring needed to be done. That was for the masses. The other factor you mentioned is that you all do have the tools at your disposal.....possibly right down the hall if something goes awry.
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Old 03-26-2018, 11:13 PM   #39
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I had my hand operated on with just a nerve block applied in my upper arm.
I was conscious and my arm was strapped in place.
I was talking to the anesthetist and I guess I started squirming around or something and they knocked me out.
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Old 03-27-2018, 05:05 AM   #40
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Conscious sedation? I do that every weekend.


Nice !!!!!


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Old 03-27-2018, 06:25 AM   #41
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I had this done for the first time the other day for a cervical epidural steroid injection. They put my on the table and I was talking to the nurses, next thing I know Iím waking back up in the pre op room. I was a little nervous but it made it easier knowing how much better Iíd feel after the injection.
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Old 03-27-2018, 06:44 AM   #42
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5 hours in the chair? Knock me smooth the f out. My claustrophobia starts kicking in after about 20 minutes.
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Old 03-27-2018, 06:51 AM   #43
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I had my hand operated on with just a nerve block applied in my upper arm.
I was conscious and my arm was strapped in place.
I had the same thing done to me for hand surgery - it's known as a Bier Block. I recall periods of sleep interrupted by someone (loudly) snoring, as well as some very inappropriate jokes and comments made by the surgeon's staff. On a post-op visit with the surgeon, I mentioned I had hear many of the comments made during my procedure, and that I wasn't pleased with the lack of decorum in the OR. When I repeated verbatim some of the comments made during the procedure, he blushed, apologized, and said he would speak to his staff about this. A few years later, I needed surgery on the other hand and I found a different hand surgeon. BTW, I never experienced any pain during my procedure.

Regards,

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Old 03-28-2018, 08:09 PM   #44
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12 hours until game time. Pretty anxious at the moment, even with the pill they gave me to get a good nights sleep. Sho hope they can get me nice and sedated. I’m a big, high strung guy so we’ll see.
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Old 03-28-2018, 09:02 PM   #45
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https://m.youtube.com/watch?v=Tdqdemnh51o
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Old 03-28-2018, 11:51 PM   #46
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I have had several ESI shots a few years ago, an endoscope a couple of years ago, and a colonoscopy last fall. All started with someone saying "ok, lets start with x amont of versed", next thing I know I am waking up in a bed or an easy chair, only to go home 30 mins or so later.
Had a valium IV for wisdom teeth surgery in 1975. I didn't care what they did, had to ask them to scratch my nose a few times. Thank god I couldn't feel anything, but the noises it made kind of freaked me out. Local wore off and I had a lot of pain, but it hurt less than the pressure the teeth were putting on my upper and lower jaw.

Don't sweat it, take pain meds as soon as you can post surgery, and keep up with them. Next day after is much better. Good luck.
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Old 03-29-2018, 07:14 AM   #47
brysdad
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Here we go, ladies and gentlemen. Headed to do something I have dreaded and put off for the last 15 years. Should be a good time. If I don’t post by lunch tomorrow that probably means I wasn’t monitored properly!
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Old 03-29-2018, 08:22 AM   #48
Goldstein
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Originally Posted by kae006 View Post
I had the pill when I had all 4 wisdom teeth removed. They said it wouldnít make me fall asleep but that I wouldnít remember any of it. They were right. I gotta wonder though, just because I didnít remember does that mean it didnít hurt?!
Wish I could say the same. I had the sedation pill when I had my wisdom teeth removed. Unfortunately, I woke up during the procedure in horrendous pain. I was ready to hurt the doc. They had to call my wife to come calm me down. Worst pain Iíve ever felt.
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Old 03-29-2018, 08:28 AM   #49
AntlerCollector
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I think dentists and their assistants prefer using the conscious sedation simply for the entertainment value. It sure makes their work day interesting
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Old 03-29-2018, 12:00 PM   #50
ByronB
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Here we go, ladies and gentlemen. Headed to do something I have dreaded and put off for the last 15 years. Should be a good time. If I donít post by lunch tomorrow that probably means I wasnít monitored properly!
LOL.....prayers up that they monitored you.
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