What's a clinician to do when a patient doesn't seem to be relaxing with the sedation? DOCS Education experts weigh in.
A DOCS Education Member inquires:
We attempted to treat a 26-year-old, 125 lb female patient with a sedation appointment today, but were unable to achieve a relaxed state with our dosing. We administered the maximum dose of triazolam at 0.75 mg, and later added N2O. When this failed to sedate our patient, we added 30 mg of hydroxizine to the regimen, to no avail. Can you suggest another regimen for the future? Thank you so much!
Dr. Wellbrock, DOCS Education Faculty member responds:
According to the TOP DOSE formula, the maximum dose of triazolam for this patient would be 1.25 mg. You could also increase the hydroxyzine to 50 mg. I would speak with the patient regarding her diet and any possible stimulant intake prior to the sedation. Was she NPO for at least 6 hours prior to the sedation appointment? Did she take her diazepam the night before? How much diazepam? Did she drink either coffee, tea or soft drinks as a source of caffeine the morning of the appointment? Is she a smoker or tobacco user? All this could come into play as for the patient being a hyporesponder.
The DOCS Education Member elaborates:
The patient does not smoke and did not take any stimulant prior to the appointment. We gave her 5 mg of diazepam and 20 mg of hydroxyzine at the start of the appointment with triazolam. It is my understanding that she has experienced mixed results with sedation dentistry in the past—sedation with triazolam did not work for her in the other office. A few weeks ago she visited an oral surgeon for a different procedure, and received propofol, which successfully sedated her. Could I give her propofol? Or should I try a different medication, such as lorazepam? She takes clonazapam and Dexedrine®, which may be affecting our results.
Dr. PJ Goyle, DOCS Education Faculty member asks:
Why is this patient taking clonezapam and Dexadrine? When does she take this medication? Did she take the medications the day of the appointment? Dexadrine is an amphetamine and counteracts sedation, so you should speak with the prescribing physician about whether the patient might abstain from the Dexadrine. Furthermore, if the patient is on clonazapam, she has likely developed a high tolerance for benzodiazepines.
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