A DOCS Education member asks: I have a female patient scheduled for two crowns and several fillings who is apprehensive about treatment. The patient’s cardiologist gave a release with precaution to avoid epinephrine.
- Baseline —
- SP02: 97
- BP: 140/74
- Rate: 75
Medications include:
- Lasix® 20 mg daily
- Lopressor® 25 mg 2x/day
- Lescol® XL 80 mg
- digoxin 0.125 mg daily
- thyroxine 75 mcg alt with 50 mcg /day
- AcipHex® 20 mg 2x/day
- Ambien® 5 mg at bedtime prn
- Lotensin® 40 mg if BP over 130
- doxycycline 100 mg every other day
- aspirin 81 mg/day
- Colace® daily
- Maalox® 2 tsp prn
- Advair® 50/250 2x/day
- amoxicillin 500 mg 4 tabs 1hr prior to dental procedure
What would you advise for treatment? If possible, I would prefer anxiolysis.
Dr. Anthony Feck, Dean of DOCS Education Faculty responds:
The hypertension appears to be under good control and you have consulted the patient's physician regarding her cardiovascular status. Find out about the severity of the patient's asthma. There are no significant drug interactions with DOCS protocol meds. This patient is actually a good candidate for sedation, especially if you must avoid epinephrine. I personally would communicate with the physician that you would like to use epinephrine judiciously, as this is most likely to put less stress on the patient's cardiovascular system than no epinephrine at all.
Follow any of DOCS Education's anxiolysis protocols that correspond to the anticipated length of the appointment. In this case, anxiolysis protocol #2 or #3 appear to be most appropriate. Have the patient bring her inhaler to the appointment.
This blog post 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.
