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how safe is "conscious sedation" for a T1D teen getting wisdom teeth removed?

Discussion in 'Parents of Teens' started by ChaosRules, Jun 8, 2015.

  1. ChaosRules

    ChaosRules Approved members

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    My son is 18, has had Type 1 for six years, and manages it OK. His A1C is in the low 7's, and he wears a pump. He does have a Dexcom G4 but never wears it.

    He needs to get his impacted wisdom teeth removed, and apparently the options at our dentist's office are:

    1. local anesthetic only
    2. local anesthetic plus nitrous oxide
    3. local anesthetic plus "conscious sedation," which they tell me is IV fentanyl (which needs 8 hours of no food/drink before the procedure)

    My son is set on having the IV sedation because of horror stories he's heard about removal of impacted wisdom teeth, but I'm worried about the IV sedation. At the very least, I will insist that he wear his Dexcom during the procedure. And I will ask if I can be present in the room, or at least close enough that I can still get readings on the receiver.

    Anyone have any thoughts on the safety issues? or any other random thoughts that might help us?

    Thanks!
     
  2. Ellen

    Ellen Senior Member

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    I think it's safer and more compassionate to have sedation than no sedation! Worked fine for my son with a DMD. Dentist had son's bg meter, nurse checked - the procedure didn't take that long (4 impacted). Make sure NO STRAWS, no sucking afterwards. We also bought those flocked ice bags and kept them on both sides for as long as he could tolerate to keep swelling to a minimum.
    Good luck.
     
  3. Megnyc

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    I had conscious sedation when I had my impacted wisdom teeth removed. It was a very pleasant experience. I doubt they will let you in the room but you probably could get a nurse to hold the receiver and monitor it. My parents sat in the waiting room at the oral surgeon's office and the nurse kept them updated. It didn't take longer than 40 minutes and all four of mine were impacted. In your position I would want to know who will be giving the sedation, what training they have had, and who will be monitoring your son while he is sedated. I think it it is pretty standard to use conscious sedation for wisdom teeth removal. All of my brothers also had it done at the same office, in the same manner as me and they all sailed through it as well.

    ETA: I would bribe him to wear the dex for the procedure and afterwards (just make sure the transmitter still works). It will be very helpful since his diet for the first few days will likely be slightly different than normal and he may also need steroids for the potential swelling. I know people here suggest to skip the steroids but I tend to lean on the side of just ramping up basal and taking the steroids because I think the discomfort and difficulty eating caused by swelling are more problematic than insulin resistance. I took 5 days of prednisone and had virtually no swelling and was on a completely normal diet within 2-3 days. Also, make sure to tell the surgeon you need to avoid tylenol if he is using the dex. Also, if you have concerns about vomiting you can request zofran to take right after the procedure and then as needed.
     
    Last edited: Jun 8, 2015
  4. ChaosRules

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    I guess I was wanting to steer him towards using the nitrous instead of IV fentanyl. Not considering using local anesthetic only!

    Thanks for the advice about no straws, and using ice bags on his cheeks. They have told us literally nothing! Apparently they thought he was still off at college (he's been home for a month) so didn't try to contact him or anything. The surgery is scheduled for this Friday, but I'm going to postpone it for a few weeks (for monetary reasons - our flexible spending plan's fiscal year starts July 1).

    They're saying 1-1/2 hours, but they're probably over-estimating.
     
  5. ChaosRules

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    Ooh, all good advice! I'll ask the questions you suggest about the person administering the anesthesia.

    The transmitter should still work because he has a new one he hasn't taken out of the box yet. We've had problems in the past after going months without using the Dexcom and then the transmitter battery was dead. So this time when the six months was up I ordered a new transmitter even though the old one was still going fine. So we have a "backup" new one to use. :smile: Thanks for the reminder about Tylenol & Dexcom.

    Good to know about the steroids and zofran. You're the reason we know about mini-dose Glucagon, too! Thankfully he didn't get sick during his first year away at college, so no probs, but it did help with my worries to know that was an option!

    Thanks, Meg!
     
  6. Riley's Mom

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    My 17 year old daughter had a lumpectomy under general anesthesia last 2 Fridays ago. She could not eat or drink after midnight. Our endo instructed to give 1/2 her dose of Levemir the night before and of course, no Novolog before procedure. The nurses pricked her finger before she went out and again in recovery - it was a 45 minute procedure. Her very first Dexcom arrived in the mail the afternoon of her surgery... So much for that... But, she did fine! You have received great advice! Oh yeah - what's the deal with Tylenol and Dexcom?
     
  7. Megnyc

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    Any medications with acetaminophen can falsely raise dexcom readings and/or cause ??? to appear instead of a reading. The extent to which this happens varies person to person but most people do see falsely elevated readings with acetaminophen. Dexcom says not to take tylenol while wearing a sensor but as long as you are aware it is a possible issue and monitor more closely for lows and don't correct off the sensor, it will not do any harm. The sensor will work fine within a few hours.
     
  8. GChick

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    I had all four wisdom teeth out at the same time and I'm pretty sure they only gave me option 2, and quite frankly... option 3 would probably be no better as far as pain etc during the procedure than option 2... though I do not know if it could possibly help with the pain after.

    I think they described it to me as "twilight" sedation or some such, either way, I had no recollection of what went on during the procedure, but they said I was talking etc.

    Due to diabetes they also would not give me steroids afterwards (this was also a number of years ago... at least 16-20) so I was swelled up like a balloon for days which was the worst part about it really.

    If he is "set" on option 3 I don't think it should be too much of a problem but will cause a few more headaches that could have been avoided due to eating timing etc... but I'd probably try to stear him to option 2. Definitely more than just option 1 though.

    Edit to add: due to it being SO long ago, and listening to the others posts it may very well have been option 3 (conscious sedation) for all I know. Also, without steroids I was eating pizza a few days later... small cut up bites, but pizza none the less.
     
  9. Riley's Mom

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    Thank you for the explanation - was not aware of this. She inserted her first sensor 2 days after her lumpectomy and was taking hydrocodone during that time - it was all so new and there was so much going on, I have no idea if she got false high readings or not. She get headaches quite frequently and takes Tylenol, so we'll be on the lookout!
     
  10. funnygrl

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    Based on unofficial discussions on Dexcom user Facebook posts, it seems the vast majority of adults, at least, don't experience acetaminophen false highs. I can't take any NSAID products, so Tylenol it is. I've taken it maybe two dozen times in the year I've been on the Dexcom and got false highs once for a few hours.
     
  11. obtainedmist

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    Our daughter had her's out with just a local. She also skipped the prednisone with the dr's approval and took just one vicodin because they made her nauseated. She sailed through it...our son on the other hand (non T1D) developed two dry sockets and was miserable afterwards! Everyone is different! Best of luck!
     
  12. wildemoose

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    I know this is an old thread but my experience might be helpful to anyone who's searching on this topic. I got my two lower wisdom teeth out under sedation last year at age 30. My oral surgeon was fantastic and I'd be happy to PM his details if you're in MA and need a recommendation. I was offered the choice of getting steroids in the IV during the procedure and I chose to take them since I was worried about going low under sedation anyway. I started around 150 and was 260 when I woke up but didn't notice any other major blood sugar issues during recovery. The procedure was super easy but recovery was rough - whether that was because of my age or diabetes I don't know, but I did get an infection in one site and had to go on antibiotics. I didn't have much pain or swelling and never took any of the Vicodin I was prescribed, just ibuprofen.
     

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