I have a fearful patient who states that she previously hallucinated when given IV Valium® at a different office. I was planning on anxiolysis with triazolam. Should I be concerned about a similar reaction? A DOCS Education member asks:
I have a fearful patient who states that she previously hallucinated when given IV Valium® during a dental treatment at a different office. I was planning on anxiolysis with triazolam (sans Valium® the night before) and was wondering if I should be concerned about similar reactions?The patient is a 31-year-old female whose medical history includes:
Heart murmur
Penicillin allergy
Smokes 5 cigarettes a day
Moderately overweight
Her treatment plan includes extractions and restorative treatment. Is it ok to move forward as planned?
Dr. Anthony Feck, Dean of DOCS Education Faculty responds:
Is it possible she has an undiagnosed psychotic condition? Any history of drug abuse? Was nitrous oxide used at the same time? Was this a true hallucination? You may never know the answers to any of these questions, so we have to take her at her word and proceed as if this was a true reaction.
Given her adverse reaction from a prior experience with diazepam, I would forego it the night before. It is not essential to the success of a sedation appointment. It is possible that such paradoxical reactions can occur with any benzodiazepine, so if it is going to happen, it is best that it happen in your office rather than at home. I would not expect it to happen, however.
I would then proceed with any of the DOCS Education protocols without the night before dose of diazepam. Dose low and slow with careful monitoring and observation. If such a reaction were to recur, then the reversal protocol is appropriate.
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.
