A DOCS Education member writes:
My patient is 42 and she reports extreme fears of dentistry following recent and difficult endodontic treatment.
The woman has several significant medical issues, including pervasive high blood pressure and injuries sustained in a car accident. As a result the patient takes a number of medications daily, including propranolol, OxyContin,â„¢ Ambien,â„¢ Zoloftâ„¢ and Amrixâ„¢. She also uses Valiumâ„¢ and Percocetâ„¢ occasionally.
While I realize numerous CNS depressants would be ill-advised for this woman prior to her sedation appointment I'm uncertain about what specific drugs she should forego. When I questioned her she stated she could go without OxyContinâ„¢ "for a day or two." My preference is that she stop the Ambien,â„¢ OxyContinâ„¢ and Amrixâ„¢ the day before the appointment but take Valiumâ„¢ the night prior. Then I propose following single-dose protocol number 2 (using 0.5 mg triazolam at the appointment). Is this what you would recommend? If not, then how would you approach the sedation of this patient?
Dr. Anthony Feck, Dean of DOCS Education Faculty responds:
Do not take your patient off existing medications as it will unnecessarily complicate their life as well as your own.
Sedate over the top of any medications used to control a patient's medical conditions. Change your sedation protocol, not the patient's medical control. What will happen if you remove the patient from her numerous CNS depressants? We can't know for sure. But we can surmise it will be unpredictable and most likely unpleasant. The result is highly like to represent an unsuccessful sedation experience.
This patient should take all of her medication as usual and not diazepam the night before. If your planned appointment is two hours or less, use single-dose protocol number 2. Do not predetermine your dose of triazolam until the patient presents, and base the amount upon the condition of the patient at that time.
