What's the role of the general dentist when it comes to leveling a patient's blood pressure for a sedation appointment? It comes down to understanding your limitations (in terms of both training and liability). Find out what two DOCS Education faculty members have to say about the topic.
A DOCS Education Member inquires:
I enjoyed your courses on airway management and maintenance. I also completed your course on incremental dosage—a lot of great information.
I do have one question about blood pressure: I perform oral sedation and also bring in an anesthesiologist. We have occasionally experienced a need-to-control high blood pressure situation with patients.
I was a little surprised that you did not suggest administering a blood pressure medicine or telling patients to bring their blood pressure medicines to the appointment, should they need it. I have added this to my oral sedation protocol for numerous patients. I also purchased some lisinopril to aid in reducing blood pressure.
Is there some reason for me to consider not adding this to my sedation armamentarium? When I read an Incisor e-newsletter case study, I thought this may be a good question to ask.
Dr. Jerome Wellbrock, DOCS Education faculty member, responds:
I find this to be an interesting post for several reasons.
For one, it is not within our realm of practice in dentistry to be administering blood pressure medication for a patient. If a patient's blood pressure is higher than what you like for sedation, or any other dental treatment, then the patient should be referred back to his physician for treatment to lower the blood pressure.
Second, if you have a patient who is taking medication for elevated BP, he should be under good control; if he is not, asking him to bring his medication to the office is irrelevant. I would not expect a patient's BP to magically drop to an acceptable level by taking a dose of his medication while in the office.
Third, if you have a patient with elevated BP during an appointment that requires medication, then using the patient's medication or administering lisinopril is not the appropriate response.
My final comments are that we, as dentists, are not here to treat a patient's standing elevated BP, and I would not add any blood pressure medication to any sedation protocol.
Thank you for posting. I hope my response is helpful.
Dr. PJ Goyal, DOCS Education faculty member, responds:
I recommend that you should not administer blood pressure medication during sedation. It is not within our training as general dentists to give BP medications, unless it is an emergency situation. Anesthesiologists have the ability to medicate to control cardiac issues because of their training.
If you choose to medicate patients with blood pressure medications, understand that it is at your personal liability. If you recognize that the patient is having a cardiac issue, the recommendation is always to stop treatment and refer.
I apologize that this was not covered in the course. I am happy to discuss this further if necessary.
The information contained in this, or any case study post in Incisor 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. DOCS Education accepts no liability whatsoever for any damages resulting from any direct or indirect recipient's use of or failure to use any of the information contained herein. DOCS Education would be happy to answer any questions or concerns mailed to us at 106 Lenora Street, Seattle, WA 98121. Please print a copy of this posting and include it with your question or request.