A member of DOCS Education asks: I have a few questions in regards to a potential sedation case.
This patient usually gets IV sedation to do his dental treatment due to fear and distrust. He has since decided to switch dentists and is now my patient. His medical history includes: HBP, thyroid condition, anemia, ulcers and a heart attack in 2005.
Questions:
- Is this patient considered ASA II or ASA III? His heart attack was in 2005 and his condition is non-incapacitating. I categorized this patient as ASA III, but I do not feel comfortable sedating a patient if they truly are ASA III.
- I was told in a previous forum that if a patient takes Valium® before treatment this is not considered sedation because there is no actual protocol being followed. Is this a correct statement?
- Situation: For the patient's first appointment I decided not to sedate him but allow him to take Valium® prescribed by his MD. Patient was prescribed by his MD diazepam 5 mg 30 minutes before his dental appointment. I suspect that the patient took more than that. He was heavily sedated. I was not comfortable with the fact that the patient took more than recommended amount. I feel that there is risk in not knowing how much Valium® was taken. My question is, can I safely sedate this patient with an actual protocol?
- Any other advice?
Dr. Anthony Feck, Dean of Faculty at DOCS Education, requested more information:
Thank you for your questions, I will address each point separately.
- The difference between ASA II and ASA III is: Does the systemic condition limit activity? If all the medical conditions are under good control and the patient does not have any limitations to normal activity, then I consider him less than ASA III.
- This statement is incorrect. If the patient takes any CNS depressant, regardless of who prescribes the CNS depressant, for the purposes of making him more relaxed prior to dental care other than nitrous oxide, then the patient is sedated.
I will need more information about your patient before I am able to provide precise recommendations. Specifically when the last medical evaluation of the patient was administered, what medications they are taking and their pre-op vital signs. As I mentioned earlier, I would consider the patient less than ASA III, but it is best to have all available information before you proceed.
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.
