The patient is a 69-year-old woman who is being treated for a number of issues related to high blood pressure and obesity. What special considerations does she present for sedation, and how dramatically must the protocol be altered to promote a successful experience? A member of DOCS Education writes:
My patient is a 69-year-old Caucasian. I plan to perform sedation on the woman. Her vitals are fine, but she does take a daily prescription in response to hypertension. Other frequent medications include 40 mg pravastatin sodium, 50 mg Zoloft™, Vitamin D, 25 mg metoprolol, 20 mg omeprazole, 25 mg hydrochlorothiazide, 4 mg Detrol™ LA, 81 mg ASA and .5 mg Xanax™ as needed.
I should add that the woman is 5’7” and weighs 220 pounds.
It will take around 3-1/2 hours to complete this patient’s treatment. I had intended to give her 10 mg diazepam the night before. In the morning in the office I planned to administer 2.5 to 3 mg lorazepam in conjunction with nitrous.
I advised the patient not to take the Xanax™ but do feel concerned about the synergistic effects of the Zoloft.™ Given all of the facts I have provided, how would you modify the medication protocol?
Dr. Leslie Fang, a member of the DOCS Education faculty, responds:
I agree it is appropriate to have her avoid Xanax™ on the morning of the sedation appointment. It is, after all, only prescribed for as-needed purposes.
However, I would not change the schedule of her Zoloft.™
Dr. Anthony Feck, Dean of DOCS Education faculty responds:
Primary concerns for me are the patient’s elderly age plus airway consequences that relate to her obesity.
I will assume you are limited to a single-dose protocol from your proposed dosages of lorazepam. When using a single-dose protocol, it’s recommended that you not decide on the dose until assessing the patient upon arrival.
In regard to this patient, I question the use of lorazepam—it’s ill-advised due to both her age and obesity. Both will cause sedation to extend longer than desired. I’d reconsider the length of your planned appointment and use a triazolam (2 hours, single-dose protocol number 2), or triazolam/hydroxyzine (3 hours, single-dose protocol number 3).
Keep the patient on all of her usual medications in the regular schedule. As Dr. Fang suggested, however, forego the Xanax™ since it’s not a routine drug.
