A member of DOCS Education writes:
My patient was diagnosed with lung cancer in April 2011. She is 65 years old and weighs 125 pounds. Her treatment included both chemotherapy and radiation. The following is a partial list of her medications: loperamide, omeprazole, temazepam, venlafaxine, ProAi®HFA inhaler and a morphine pump (dose is 2 mg each hour).
Following represents a partial list of the woman’s current daily medications:
The woman’s baseline vital signs include blood pressure of 101/74, pulse 78 beats per minute and oxygen saturation of 91 percent.
Her dental treatment recommendations are full-mouth extraction and complete dentures. With the continued morphine pump I assume the cancer prognosis is poor. I am inclined to refer her to an oral surgeon for the extractions.
Dr. Lesley Fang, Medical Director of DOCS Education Faculty, responds:
The woman is ASA IV. The presence of lung cancer and likelihood of metastatic disease (necessitating chemotherapy and radiation) warrant a look at her life expectancy before embarking on ANY procedure whatsoever. For example, we’d not likely intervene for angina in this patient, and that is far more life-threatening than any dental needs.
Dr. Anthony Feck, Dean of DOCS Education Faculty, adds:
Your patient has a medical condition that is a constant threat to her life—therefore she satisfies the definition of ASA IV. The fact that she is elderly makes this even more of an issue with sedation. My recommendation is that she be sedated in a facility where the operator and the anesthesiologist are two different individuals, she has an IV in place, and advanced emergency medical attention is readily available.
