A member of DOCS Education poses a question to the faculty:

Our office saw a 63-year-old female patient with BMI of 29.5 who presented for a LANAP™ procedure. The patient has a history of high blood pressure which is well controlled on current medications. Aside from the blood pressure issues, the patient has an unremarkable medical history. I had contacted DOCS Education weeks prior to beginning the patient’s procedure due to our concern of Class IV Mallampati. The total dose of triazolam we administered throughout the procedure was 1.25 mg with a Top Dose of 1.75 mg. While I was using an ultrasonic scaler on the patient, she began to cough and developed stridor lasting approximately five or so seconds. This occurred twice while using the ultrasonic scaler, and it seemed to be a result of the liquid going down the patient’s throat. The patient was responsive; she swallowed and was able to follow commands prior to this occurring and quickly returned to a normal state afterward. The patient had a third occurrence when the appointment was completed and she started to sip juice. She began to cough, and then stridor developed, lasting about five to ten seconds. The patient is scheduled on Friday for the next two quadrants for LANAP™ under oral conscious sedation. I would be interested in hearing your thoughts and concerns before the next round of treatment.

Dr. Jerome Wellbrock, DOCS Education faculty, responds:

If this was a true stridor we would have expected this to be a laryngospasm, and it most likely would not resolve on its own in a matter of seconds. It does sound like she is swallowing or inspiring some water resulting in her cough. My advice is to keep the sedation light again and provide the best suction possible, perhaps altering the patient’s position in the chair for best control.

The DOCS Education member replies:

Thank you for your prompt response. It is possible that the incidents were closer to 15-30 seconds; they were not, in fact, timed. I agree that it seemed to be directly in response to having fluids hit the back of the patient’s throat. I’m verifying that your opinion is the same.

Dr. Wellbrock responds:

I am still of the same opinion. If it was a laryngospasm it would have the potential of lasting until the patient passes out and the vocal cords relax. In such a case you would support the patient with positive pressure oxygen until the patient resumes normal breathing. The severity of what you experienced with your patient does not sound like true laryngospasm. You still want to do everything possible to prevent fluids from entering the airway.

Disclaimer

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.

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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.
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