I know that pregnancy is a contraindication for oral conscious sedation (OCS). But I have a patient that is trying to get pregnant and wants OCS. She said that she is willing to take a hospital administered pregnancy blood test shortly before the treatment visit. My question is how accurate are these tests (false negatives), and how long would a negative test be good for? Three days? Seven days?
A hospital administered pregnancy blood test just prior to the appointment should give you enough confidence that the patient is not pregnant. The issue is that she is trying. What happens if she shows up for her appointment (maybe with your diazepam or pre-op dose of triazolam) with a positive test? Not only is that a problem with your schedule for that day, but also with the developing baby.
I know this goes without saying, but you must not only require a pre-appointment pregnancy test, but that she stop trying from the time she schedules the appointment and until after the appointment at four times the half life of the sedative drug administered during the appointment. (That is, after the last dose is administered - from that point forward, wait 4 X the half-life of that drug - bare minimum - I would add some extra time - another 12 hours onto that just for good measure - that's not scientific, just my nature).
Dr. Leslie Fang, DOCS Education Faculty responds:
I do believe that we should be overly-diligent in not using a category D or category X drug and should continue to make sure that we set it in stone to ask (and verify) in as many ways as possible to avoid using triazolam with a potentially pregnant woman.
However, we should be aware of the fact that many young females are on benzodiazepines some of them do have unplanned pregnancies. On the medical side, we caution our patients about coming off of benzos if they are planning pregnancy and would take them off of benzos if they have an unplanned pregnancy.
This blog post 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.