The 45-year-old woman is in otherwise good health. However, she complains of dysphagia. How does this affect the choice of hydroxyzine, or for that matter her appropriateness as a sedation candidate? A member of DOCS Education writes:
I am planning to sedate a patient using protocol number 1. She complains of dysphagia (not gagging). Would you consider the use of hydroxyzine in this case? Another possibility that occurred to me is a decongestant to clear her nasal passages. The woman is 45 and otherwise in good health.
Dr. Jerome Wellbrock, responds:
I have a couple of questions. Does this patient experience trouble swallowing everything or just difficulty with pills? Does she have trouble breathing through her nose? Does she have any other airway obstruction? Hydroxyzine can help clear nasal congestion. Hydroxyzine can be crushed and mixed with a little water to make a slurry that’s easy to administer.
Dr. Anthony Feck, Dean of DOCS Education faculty responds:
Sedation is highly likely to help the challenges posed by this patient. It is hard to swallow when one’s mouth is open. However, sedated patients experience less need to swallow in general. The reasons are because of their sedated state of consciousness, the drying nature of these medications, and the physical barriers used on sedated patients to prevent fluids from accumulating in their oropharynx.
Hydroxyzine will almost certainly help on account of its drying effect, as will prevention of drainage that would stimulate the swallowing reflex.
