Sedation of diabetic patients is managed by allowing the patient to take a light breakfast and ending the appointment in advance of lunch so that the patient can maintain their blood sugar. A significant number of type-2 diabetic patients have undergone some form of bariatric surgery to manage their condition. How does this affect the sedation appointment? DOCS Education faculty weigh in.
A DOCS Education member writes in:
We will be sedating a 49-year old female with type-2 diabetes. She had gastric bypass surgery 15 years ago, and her blood sugar is well-maintained. The patient stated that oral sedation medication metabolizes much quicker in her system as a result of her surgery. Are there any recommendations or new protocols for this patient?
Dr. Jerome Wellbrock, DOCS Education faculty member, responds:
Sedation pharmacodynamics depend on the type of gastric bypass she recieved. If she had a Roul-EN-Y or gastric sleeve surgery, then the medications will pass through more quickly, so you may see a faster onset of sedation but a shorter period of sedation since the meds keep moving and are not as well absorbed. If she has a Lap-Band then the meds will pass through more slowly so you may see a longer onset time but longer duration of sedation. My advice is to use an incremental protocol and depending on her gastric procedure you will have to adjust your dosing frequency.
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