She Was Pregnant When Sedated, But Didn’t Know It
Stock Photo

 

One of the many privileges of DOCS Education membership is access to our EliteDOCS® Forum, an exclusive 24/7 online community where there are always fellow dentists and faculty members happy to respond to requests for advice and support.

What follows is a recent post and two responses from the EliteDOCS® Forum. The post and replies are edited for clarity and brevity.

 

She Was Pregnant When Sedated, But Didn’t Know It

A member in Indiana is concerned after learning that a sedation patient he treated was already pregnant at the time, although all the paperwork that she signed clearly stated that she was not pregnant.

 

Wrote the dentist:

I (recently) saw a patient for oral conscious sedation. She didn’t know that she was pregnant at that time. All of her paperwork was completed stating that she was not pregnant and was not planning on any pregnancy.

The patient returned today for her hygiene appointment and stated that she now knows she is six weeks pregnant. She said she had no knowledge of being pregnant when she had the sedation appointment.

Originally, the patient was given diazepam 5 mg the night before her appointment, and a total of 1.25 mg of triazolam the day of the appointment.

Is there anything I need to do in this case?

 

John P. Bitting, Esq., DOCS Education’s Regulatory Counsel, responds:

Make sure you keep those records safe where she said on more than one occasion that she was NOT pregnant. Be sure to also document when she told you she is pregnant.

Did you remind her that she told you twice that she was not pregnant nor planning on becoming pregnant? If so, definitely document that was well.

You could ask her to sign a release of all claims, but it’s probably too soon for that, and might just make matters worse. You probably want to hold off on doing that unless and until it becomes necessary. It could just turn out to be a normal pregnancy.

 

DOCS Education Faculty Member, Jerome Wellbrock, DMD, MAGD, also responds:

You need to make sure that you are asking more on your pre-op history and interview.

If any answer is questionable, a female staff member could ask, “Have you had sex since your last period?”

It may seem like overkill but considering the importance of knowing, it is reasonable to ask in any way you can.

 

Original Posting: https://www.docseducation.com/forum/pregnant-patient

 

Seeking Advice for My Very First Sedation Case

A general dentist in Point Pleasant, New Jersey, is about to treat his first sedation patient, a 47-year-old male gagger. Is his treatment plan correct?

 

Wrote the dentist:

I’m doing my first oral sedation case in two weeks. The patient is an ASA 2 47-year-old male. Controlled hypertension. Repaired coarctation of the aorta when he was five years old. Medications are omeprazole, Lisinopril, and hyoscyamine.

He’s a gagger. His dental needs are three posterior crowns and two fillings. He needs four hours of sedation. I am thinking of doing incremental protocol number two with triazolam and hydroxyzine.

Again, this is my first case. I’m totally a newbie and any assistance would be greatly appreciated.

 

Dr. Anthony Carroccia, of St. Bethlehem Dental Care in Clarksville, TN, a long-time DOCS Education member, Diplomate, and EliteDOCS administrator, responds:

Welcome, and best wishes!

That protocol sounds like a great choice. I used LexiComp (a must with sedations) and saw no untoward interactions of those medications.

My concern is the gagging and him taking omeprazole and hyoscyamine. Those medications suggest GERD, IBD, or possibly some other GI issue.

Suctioning will be key to help the gagging and prevent a vomiting episode. I would use nitrous oxide cautiously in this instance, if you were considering it for the gagging/impressions, etc.

 

Original Posting: https://www.docseducation.com/forum/my-first-sedation-case

 

Stock Photo
Stock Photo

How Best to Sedate a 75-Year-Old Patient?

A Gold member in Joplin, Missouri, plans a five-hour appointment with a 75-year-old male. What precautions should he take?

 

Wrote the dentist:

We are concerned about the patient’s age and want to see if you have any recommendations. His sedation appointment will last approximately five hours with minimal bleeding.

The patient is a white male, healthy, with no previous surgery or medical conditions. We have medical clearance from his general physician. He takes pantoprazole 40 mg for his heartburn.

The patient says he is hard to sedate.  Weight 225, high 5’10, blood pressure 133/80.

The planned protocol is 2.5 mg diazepam the night before his appointment. 1 mg lorazepam, and 10 mg hydroxyzine one hour before treatment begins.

 

Allan Schwartz, DDS, CRNA, a DOCS Education instructor and veteran anesthesia teacher, responds:

It seems to me that five hours of surgery is a long time for this patient. Among many things you should consider are hydration, blood sugar, discomfort, skin integrity, deep vein thrombosis, and bleeding.

I would split the appointment if you possibly can.

 

Dr. Anthony Carroccia, of St. Bethlehem Dental Care in Clarksville, TN, a long-time DOCS Education member, Diplomate, and EliteDOCS administrator, responds:

In a geriatric patient, you never know when you will have a hyper responder who can be more deeply sedated than intended. This is a good starting point that you’ve selected (assuming you meant 100 mg of hydroxyzine vs. 10).

You have been warned though that the patient is hard to sedate. This could end up as a test sedation as well.

 

Original Posting: https://www.docseducation.com/forum/sedation-protocol-elderly-patient

 

Stock Photo
Stock Photo

Drugs and Refrigeration

A member in Bloomfield Hills, Michigan, wants to know the safe way to draw up sedation drugs ahead of seeing a patient.

 

Wrote the dentist:

Can I draw up drugs the night before treating a sedation patient or is that not standard protocol?

I was trying to find a locking refrigerator to store the drugs that are drawn up for the following day and was told propofol and fentanyl and other sedation drugs do not have to be refrigerated after opening.

 

DOCS Education Faculty Member, Jerome Wellbrock, DMD, MAGD, responds:

It would never be standard practice to draw up drugs for any patient prior to the scheduled appointment and the patient being present in your office.

 

John P. Bitting, Esq., DOCS Education’s Regulatory Counsel, also responds:

Please keep in mind that propofol is a general anesthetic and shouldn’t be used for moderate IV sedation.

 

Original Posting: https://www.docseducation.com/forum/drugs-and-refridgeration

 

Lindsay Olsen, our Membership Director
Lindsay Olsen

 

YOUR TURN:

Do you have pharmacology, protocol, practice management, equipment/drug, or regulatory questions you’d like answered? Likewise, would you like to lend your voice and experience to help fellow dentists from around the country?

EliteDOCS forum members are connected to one another – and to our faculty – 24/7. There are always friendly and knowledgeable fellow dentists online who are happy to respond to requests for advice and support.

To join our DOCS Education community of professionals serving at the forefront of dentistry, and receive all of the privileges to which membership entitles you – including access to EliteDOCS – visit us online here, or contact Lindsay Olsen, our Membership Director, at 206-812-7712.

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 3250 Airport Way S, Suite 701 | Seattle, WA 98134. Please print a copy of this posting and include it with your question or request.
DOCS Membership
Upcoming Events
WA
November 08- 10, 2019

More Articles