Having done a little research it appears that intravenous dental sedation for extraction of my wisdom teeth will not present significant complications because of my ME/CFS.
Here is the long version …
I’ve found out that in the UK gas and air is only used in hospitals now and sedation at local practices is going to be intravenous. Indeed this is the kind of dental sedation I had last time I had two of my wisdom teeth out.
I’m only going to look at IV sedation in this post.
Most use benzodiazepines or “benzos” and the most frequent drug used is Midazolam (called Versed in the US, Hypnovel or Dormicum in the UK), but occasionally Diazepam (tradename: Valium) is used.
Not only does the drug have an amnesia effect, meaning you can’t recall much or sometimes any of the procedure, but it also makes you very relaxed whilst co-operative with the dentist.
Sedation “induces a state of deep relaxation and a feeling of not being bothered by what’s going on“.
This is from a really good and informative guide to IV dental sedation from Dental Fear Central.
So on the whole I shouldn’t be anxious or stressed during the extraction. I know from first hand experience that I won’t remember much – in fact I don’t remember anything at all from last time between the injection of the sedation and trying to pay afterwards!
From a short research session on the internet it appears that persons with ME/CFS (PWME) can be very sensitive to drugs like Midazolam but they are generally well tolerated. It’s advised to start with a small amount and increase as required. See Recommendations for Persons with Chronic Fatigue Syndrome (or Fibromyalgia) Who Are Anticipating Surgery from Immune Support
In fact they are reccomended by some as part of good anaesthetic practice for persons with ME/CFS rather than using histimine releasing medication which we often have problems with.
“With CFIDS patients, I recommend Diprivan (propofol) as the induction agent; Versed (midazolam), fentanyl (a short-acting narcotic) and droperidol (an anti-nausea agent) during the anesthetic; and a combination of nitrous oxide, oxygen and isoflurane (commonly called Forane) as the maintenance agent.” Taken from Anaethesia and ME on A Hummingbirds Guide to ME.
Your pulse, heart rate and blood pressure are monitored during the procedure.
PWME who have problems with blood pressure and/or vasovagal syncope (neurally mediated hypotension) should be monitored carefully. Again see Recommendations for Persons with Chronic Fatigue Syndrome (or Fibromyalgia) Who Are Anticipating Surgery from Immune Support.
Special attention should also be paid to PWME who have Postural orthostatic tachycardia syndrome (POTS). It is also important to be well hydrated.
“Because of the prevalence of low blood volume, care should be taken to hydrate patients prior to surgery and to avoid drugs that stimulate neurogenic syncope or lower blood pressure.“
Suggest that your patient prepare for both surgery and major dental work by:
Taking 500 mg Vitamin C daily, plus a good multi-vitamin/mineral supplement
Taking homoeopathic amica, 4 per day, 2 days before and continue for 2 weeks.”
Dr Sarah Myhill.
See Anesthesia & Procedure Preparation Information from the Northern Virginia CFS/FMS Support Group (thanks to Nina!).
Interesting grapefruit juice can increase the effects of Midazolam. There’s a long list of drugs and suppliments with contra-indication according to answers.com but no indication of how significant a lot of them are. It’s important to tell your dentist about any medications for birth control, anxiety, sleep, depression, HIV, anti-fungals, pain, antibiotics, hay fever, allergies, blood pressure, heart problems and seizures amongst others. Also if you intake a lot of caffeine or alcohol.
My lovely dentist assures me I will be able to discuss any contra-indications with my current medications with the dental surgeon. I’m most interested in how my amitriptyline and midazolam will interact, as this is a drug I am using everyday. We’ll see what he says.
Side effects of midazolam can include a sort of hangover effect, sleepiness, restlessness, headache and loss of memory (the latter being part of the point of taking it for an extraction!). If you experience any breathing difficulties, fast or irregular heart beat, hallucinations, numbness or tingling in hands or feet, seizure or rash you should seek medical advice as soon as possible.
The only side effects I had last time was the drowsiness and memory loss. You definately need someone to escort from the appointment and I would say to be with you for at least several hours aftwerwards. If you are also having a sedative prior to arriving at the dentist you will also need someone to escort you there. It might also helpt to have someone to sort the bill out for you after the treatment because although I was able to enter my PIN I had no idea why I was doing it or how much it was for!
In summary it seems that like with all drugs persons with ME may be sensitive to IV dental sedation and some of the drugs used to manage our condition may be contra-indications. But generally the sedation is well tolerated and certainly allievates much of the anxiety of a dental surgery like wisdom teeth extraction. I think the anxiety of not having the sedation would have a much greater impact on my ME than the midazolam!