A DOCS Education Member poses a question to the EliteDOCS forum:
I am seeking advice on an upcoming treatment with a 54-year-old female patient. Patient requires a broad array of dental treatments including endodontics, extractions and fillings. Patient presents with the following medical history:
- BP 140/78
- 2-3 small epileptic episodes per month, including stiffening of the body
- Depression
- Inconsistent memory from a traumatic brain injury caused by an auto accident five years prior
Patient’s current medications include Abilify®, Aricept®, Klonopin®, Lexapro®, Nexium®, Topamax® and Vimpat®.
My research indicates that the patient’s medications are C interactions with the DOCS OCS drugs and there should be no issues in sedating this patient. I would like to confirm that this is the case and that I haven’t missed anything before I proceed with the appointment.
Thank you in advance for your assistance.
Dr. Anthony Feck, DOCS Education faculty, responds:
Your patient should have had a medical evaluation within the past 12 months. Patients with seizure disorders are less likely to have a seizure when being sedated with a benzodiazepine. Still, it is possible—even more so if reversed with flumazenil. Therefore, be prepared to address appropriately in the event of a seizure, and sedate to the lightest level that still gives the patient a comfortable experience. I do not recommend the use of diazepam the night before due to the number of CNS depressants the patient is already taking. Otherwise, precede with any of the DOCS protocols that are appropriate for your patient.
The information contained in this, or any case study post in Incisor should never be considered a proper replacement for necessary training and/or education regarding adult oral conscious sedation. Regulations regarding sedation vary by state. This is an educational and informational piece. DOCS Education accepts no liability whatsoever for any damages resulting from any direct or indirect recipient's use of or failure to use any of the information contained herein. DOCS Education would be happy to answer any questions or concerns mailed to us at 106 Lenora Street, Seattle, WA 98121. Please print a copy of this posting and include it with your question or request.
