A member of DOCS Education asks:
My patient is a 21 year old female who presents for IV sedation and operative dentistry. She smokes 0.5 packs/day, reports she has bronchitis but has no medication for such. She also states she takes Depakote® for bipolar disorder and Propranolol for tachycardia. Lexicomp shows no interactions with the Depakote® and only a C rating for Fentanyl (a non-benzodiazepine) and Propranolol. No other interactions are listed.
Her PCP clears her for IV sedation but her psychiatrist MD writes "may give low dose benzodiazepine for procedures only". Am I missing something here? I don't understand the reason for the cautionary statement, especially given that I can stay away from the Fentanyl, and it's in direct conflict with the Lexicomp analysis.
Thanks for the input.
Dr. Jerome Wellbrock, Live Patient Experience Director at DOCS Education, responds:
I have no idea of the reason behind the recommendation. We don't know what the physician means by "low dose." I think a conversation with the physician would probably answer all your concerns. I ran Lexicomp interaction analysis and I would be more concerned about the amount of vasoconstrictor used in the local anesthetic since she is taking the Propranolol. I would also want more information on the bronchitis; is it acute, chronic, reason for no treatment, any compromised respiratory function? If the bronchitis is acute then I would wait until the condition is completely resolved before beginning treatment.
Dr. Leslie Fang, DOCS Education Faculty, adds:
I guess the question becomes:
1. Does she need sedation for planned intervention? 2. If so, does she need IV sedation?
I agree with Dr. Wellbrock that the better part of valor is to discuss this with the psychiatrist, who may not be familiar with the sedation needs in dentistry.
