ADMA Training

TYPES OF IV FLUIDS USED IN DENTAL SEDATION

Written by Cory Pickens | March 07, 2025

In IV sedation for dental procedures, fluids are used for hydration, medication delivery, medication dilution, and maintaining hemodynamic stability. The choice of IV fluid depends on the patient’s medical condition, sedation depth, and procedure duration. Below is a breakdown of commonly used IV fluids in dental sedation.

  1. Crystalloid Solutions (Most Common) - Crystalloid fluids contain electrolytes and water, making them the primary choice for IV sedation. They are classified based on their tonicity:
      • Isotonic Fluids
      • Hypotonic Fluids
      • Hypertonic Fluids
A) Isotonic Fluids (Most Used in Dental Sedation)
  • Osmolarity ~ 275-310 mOsm/L (similar to blood plasma).
  • Used for hydration, maintaining BP, and as a carrier for sedation drugs.

IV Fluid

Composition

Use in Dental Sedation

0.9% Normal Saline (NS)

Sodium (154 mEq/L), Chloride (154 mEq/L)

Most common IV fluid for hydration and dilution of IV sedation drugs (e.g., Midazolam, Fentanyl, Propofol). Helps maintain BP.

Lactated Ringer’s (LR)

Sodium (130 mEq/L), Potassium (4 mEq/L), Calcium (3 mEq/L), Chloride (109 mEq/L), Lactate (28 mEq/L)

Used if mild acidosis or longer sedation cases. Preferred for patients with hypovolemia.

Plasma-Lyte A or Normosol-R

Balanced electrolytes, Acetate, Gluconate

More physiologic than NS. Used for longer sedation procedures or patients with metabolic concerns.

Best choice for most dental sedation cases → 0.9% Normal Saline (NS) or Lactated Ringer’s (LR).

 

B) Hypotonic Fluids (Rarely Used in Dental Sedation)
  • Osmolarity < 250 mOsm/L (lower than blood plasma).
  • Used for severe hypernatremia.
  • Not typically used for routine dental sedation due to risk of hypotension and electrolyte imbalances.

IV Fluid

Composition

Use in Dental Sedation

0.45% Half-Normal Saline (½ NS)

Sodium (77 mEq/L), Chloride (77 mEq/L)

Rarely used; might be considered in diabetic or elderly patients with dehydration risks.

5% Dextrose in Water (D5W)

Glucose (50 g/L)

Not typically used for sedation unless patient needs mild caloric support or hypoglycemia prevention.

Avoid for routine sedation → Can cause fluid shifts and hypotension.

 

C) Hypertonic Fluids (Rare in Dental Sedation)
  • Osmolarity > 375 mOsm/L (higher than blood plasma).
  • Used in emergency settings (e.g., hypotensive crisis).
  • Not used in routine dental IV sedation.

IV Fluid

Composition

Use in Dental Sedation

3% Hypertonic Saline

Sodium (513 mEq/L), Chloride (513 mEq/L)

Only used in critical cases (e.g., severe hyponatremia, brain injury).

Not recommended for routine dental sedation.

 

  1. Colloid Solutions (Rarely Used in Dental Sedation)

Colloids contain larger molecules (proteins, starches) that stay in the bloodstream longer and expand plasma volume. They are only used in special cases where rapid fluid resuscitation is needed.

Colloid Fluid

Composition

Use in Dental Sedation

Albumin (5% or 25%)

Human albumin protein

Used in hypovolemic, hypotensive, or critically ill patients. Rarely needed for dental sedation.

Hetastarch (Hespan)

Synthetic starch

Expands plasma volume but rarely used due to bleeding risk.

! Not needed for routine sedation.

 

CLINICAL PEARLS:

Choosing the right IV Fluid for Dental Sedation is important. The Best Choices for Most Dental Sedation Cases:

  • 0.9% Normal Saline (NS) → Standard choice for drug dilution, case maintenance & hydration.
  • Lactated Ringer’s (LR) → For longer cases or mild metabolic imbalance.
  • `Diabetic patients → Consider ½ NS or D5NS if needed.
  • Elderly patients → Avoid hypertonic fluids to prevent fluid shifts.
  • Hypotensive patients → Use NS or LR with fluid boluses.
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