A DOCS Education member seeks the faculty’s assistance:
What is the protocol for sedating a healthy 15-year-old female with midazolam?
Dr. Jerome Wellbrock, DOCS Education faculty, responds:
Could you provide me with more information, please? Oral midazolam or IV midazolam? What is your patient's height, weight, airway evaluation, vital signs, planned dental treatment, expected length of time of treatment? All of these pieces of information will allow for the safest and most accurate advice.
The DOCS Education member responds:
The patient weighs 160 lb and will be receiving composite restoration. Her appointment length should be approximately one hour. She is ASA-1, Mallampatti-2. I spoke with her mother and recommended the patient discontinue allergy meds Zyrtec®, Astepro® and fluticasone the day of the appointment.
Dr. Jerome Wellbrock responds:
Astepro® is an H1-antihistamine that is listed as an "X" interaction with all of the sedation meds. Astepro® has a duration of action of 12 hours, but has a half-life of 22-25 hours. Therefore it will be in your patient for a few days before it is completely eliminated.
You may want to consider a physician consult on asking this patient to stop any of her meds. As for the sedation protocol, I do not use midazolam in teens. We will have you follow up with Dr. Sanger or another of the pediatric faculty for their advice on this matter.
Since your patient is taking three medications for her allergies and nasal congestion, it’s important to consider the ramifications on airway patency if she is taken off any of her meds.
The DOCS Education member asks:
What is the reason you would not use midazolam as sedation for teenagers?
Dr. Jerome Wellbrock responds:
Mostly, I seldom sedate teens. When I do, IV midazolam is my first choice. I do not use oral/nasal midazolam in my practice.
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.
