In this week’s case study, a DOCS Education member questions whether his patient’s health-risks will allow for sedation.
A member of DOCS Education asks:
Hello doctors. I have a 64 year-old female patient taking 150mg ranitidine twice a day, 40 mg of omeprazole twice a day, 1mg of Arimidex® once a day and 50mg of tramadol as-needed for pain. The patient has a history of cancer, a double mastectomy, arthritis, heart murmur, hypertension, high cholesterol, Crohn's Disease, Raynaud's phenomenon and a severe dental phobia. Based on these health concerns and medication regiments, I am wondering if she is a sedation candidate, and if so, could you please suggest a medication protocol for this patient?
Dr. Anthony Feck, Dean of DOCS Education Faculty, responds:
If you have had a medical consult with the patient's doctor and the physician cannot come up with any contraindications to the patient having outpatient sedation, and the patient's ASA classification does not rule out sedation in your office, then you can use any DOCS Education sedation protocol. If you're limited to single dose minimal sedation then choose a protocol based on the length of the appointment. If you can incrementally dose, the preferred protocol is Incremental protocol #1, aka the Golden Protocol.
Given the patient's age she could hyperrespond, and due to her use of tramadol she might hyporespond. As such, using an incremental protocol is preferred as it allows you to dose in low increments.
Dr. Lesley Fang, Medical Director of DOCS Education Faculty, adds:
While I appreciate your concern as your patient has had an extensive medical history, I do not believe you should be worried as she is not as complicated a patient as she would first appear.
Her breast cancer has been dealt with by both a mastectomy and she is now on Arimidex®. This is a good sign as there is no evidence of metastases. Her GERD is being controlled by the omeprazole, and her arthritis is tempered by the tramadol. Her Chron's and Raynaud's are conditions to be aware of, but as she is not taking medications for these issues, there is nothing to interfere with sedation..
I agree with Dr. Feck and his selection of the Golden Protocol if you are able to incrementally dose.
