A DOCS Education member seeks the faculty’s assistance:
I’m seeking advice on a 47-year-old male patient. I believe he is an ASA II individual. His blood pressure and pulse are WNL (131/83 & 68). He has a history of arthritis, kidney disease (renal insufficiency which patient says is categorized as stage II chronic kidney problems related to the meds he's taking), and lastly HIV.
He's on the following meds:
- Prilosec®, 20 mg 2 times/day (Stomach)
- Wellbutrin®, 400 mg 1 time/day (Anti-depressant)
- doxepin, 50 mg 1 time/day at bedtime (Sleep)
- Viramune®, 400 mg 1 time/day at night (anti-viral drug)
- Epzicom®, 300 mg 1 time/day (treatment of HIV infection)
- alprazolam, 2 mg 1 time /day (sleep)
The Lexicomp Interaction Analysis shows a category "D" rating for all local anesthetics with vasoconstrictor, diazepam, doxepin, triazolam, and Viramune®. His medical doctor has cleared him for sedation.
The patient says he can do the treatment without sedation if need be but we are doing a long (5-6 hour) cosmetic case on him. If sedation is safe in this situation, it would make the treatment experience much nicer for him. What is your recommendation? The patient is scheduled next week, so a reply as soon as possible would be appreciated.
Thank you very much for your assistance on this patient.
Dr. Anthony Feck, Dean of Faculty at DOCS Education, responds:
For the patient taking Viramune®:
If you sedate, you should not use diazepam or triazolam in the protocol. Use a lorazepam or lorazepam/hydroxyzine protocol (incremental protocol #3 or #4 without diazepam the night before). Use local anesthetic with vasoconstrictor judiciously and administer slowly while monitoring carefully.
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.
