I have a question about an experience that I had with two anxious patients recently. I used anxiolysis protocol #3 on both patients.
The first patient was a 50-year-old female weighing 120 lbs. She smoked one pack a day for 20 years. Her initial BP was 110/69, PO2 98%, and pulse at 71. She was not on any medications.
The second patient was a 51-year-old female who smoked 1 pack a day for 35 years. Her initial BP was 120/76, PO2 99%, and pulse at 65. At the time of treatment, she was taking atenolol 50 mg daily, Paxil® 30 mg daily, allopurinol 300 mg daily, ranitidine 150 mg 2x daily, and levothyroxine 0.125 mg daily. This patient was placed on supplemental oxygen because her O2 reading fluctuated.
Both patients were very restless during their procedures. They moved around constantly and their arms and legs were rarely still. It made completing their treatments very difficult and wore me out. I have done about 50 sedations since becoming certified and used Halcion® as a single-dose treatment prior to then. These appointments were the only times I have experienced this. I am wondering if I should have administered more meds to the patients? Any input would be greatly appreciated.
Dr. Anthony Feck, Dean of DOCS Education Faculty responds:
Administering more oral sedation medication is seldom the answer to a fidgeting patient. If they were adequately sedated, then giving more medication just adds to the management problem.
Be sure to rule out low blood sugar, the need to go to the bathroom, anxiety, or pain before calling it a day. You can avoid some of these situations by knowing who the Restless Leg Syndrome (RLS) patients are, and avoiding sedating patients with a psychosis. We now ask patients if they are restless sleepers or sleep walkers (not that they fall asleep, but because these patients tend to move more when sedated).
This blog post 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.