A DOCS Education member seeks the faculty’s assistance:

I have an 18-year-old male patient who presents with well-controlled bipolar disorder. The patient has had his last physical within one year. The patient is currently taking 1 mg of clonazepam h.s., fluoxetine in the morning and 1 mg of risperidone h.s.

The proposed treatment is for multiple fillings in the whole mouth. The procedures will span several long appointments lasting approximately four to six hours each. My question is in regards to the OCS protocols, and if there are specific concerns related to bipolar care?

I believe it is safe to assume that with the medications the patient is taking we should not give diazepam the night before the appointments. Incremental triazolam would be my usual protocol choice. Would lorazepam only be used here for the long appointments if he were to have a contraindication to the triazolam?

Additionally, I seem to remember that schizophrenia dx is contraindication to OCS, is that correct?

Thank you.

Dr. Jerome Wellbrock, DOCS Education faculty, responds:

You have a good handle on this one. Skip the diazepam the night before. If your patient has well controlled bipolar dx, then an incremental protocol with triazolam will be sufficient. Dose low and go slow. Make sure to calculate your TOP DOSE.

In regards to your question on schizophrenia, the condition is a contraindication for oral sedation but is okay for IV sedation. If a schizophrenic patient were to exhibit unwanted behavior with minimal sedation then it would be more difficult to sedate past that behavior using OSD. IV sedation, however, allows you to titrate the sedation to move past any unwanted erratic behavior.

 

The DOCS Education Member gives thanks:

Thank you Dr. Wellbrock. I am always grateful for the EliteDOCS forum and the expert advice that comes with it.

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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