A DOCS Education member seeks the faculty’s assistance:
I am considering sedating a patient of mine that is taking 120 mg per day of diltiazem. He has a history of cardiac ablation but is otherwise healthy. This will be my fourth sedation and the first with a "D" drug interaction. Would this patient be an ASA II? Also, should the initial doses of diazepam and triazolam be reduced? Should I use a different protocol? And finally, should I even be sedating this patient?
The patient weighs 201 lb, baseline pulse is 59, O2 96 percent, BP 137/83.
The DOCS Education member adds:
Other meds taken by patient include:
- Flecainide 150 mg b.i.d
- Omeprazole 40 mg b.i.d.
- Bayer® Aspirin one per day low dose
- Escitalopram 10 mg one per day
- Interestingly, Lexi-comp has an X interaction between escitalopram and flecainide.
Dr. Jerome Wellbrock, DOCS Education faculty, offers his advice:
I would recommend against sedating this particular patient in your office, especially at this point in your sedation training and experience. He could be an ASA II or an ASA III depending on his physical abilities and any limitations.
I would lean towards an ASA III without any other information. He has had cardiac ablation which indicates previous serious cardiac rhythm abnormalities. He is still taking diltiazem and flecainide to control or prevent life threatening arrhythmias. Lastly the diltiazem as you mentioned is a "D" interaction with both the diazepam and triazolam.
Bottom line is I recommend passing on this one for now.
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.
