A member of DOCS Education writes:
My patient will soon arrive for a sedation consult. He is 46 and suffers from an extremely severe gag response. He requires a crown on a posterior tooth. We simply wouldn’t be able to perform this treatment without the use of sedation.
The man has revealed Stage I hypertension in our office, but otherwise presents as a healthy individual. He currently takes no medications. My primary concern has to do with his BMI. It ranges very close to the point beyond which our sedation level certification ends. Furthermore, his neck is quite large. I remember hearing a number associated with neck circumstance that is a contraindication for sedation treatment. I’ve reviewed by notes but can’t find this figure.
Dr. Anthony Feck, Dean of DOCS Education Faculty, responds:
DOCS Education’s Sedation Solutions course specifically addresses the issue of neck circumference. A neck measuring 17 inches in men and 16 inches in women is a clinical characteristic common among patients with obstructive sleep apnea.
I need to clarify that this measurement is not by itself a contraindication for OCS. However, it does present an indication that your patient is at high risk of a compromised airway. Certainly you should consider it a red flag. In response, keep sedation light, use 100 percent supplemental oxygen, and specially monitor the airway throughout.
