A member of DOCS Education writes:

I am sedating a highly anxious 32-year-old female who is ASA 1. I prescribed her 5 mg diazepam to take the night before the appointment. The patient weighs 145lbs. Please confirm that her max dose of lorazepam is 5.8 mg.

Since I am practicing a single-dose protocol, should I administer 5 mg when she gets to the office? Is that sublingually or orally? The appointment is 4.5 hours long.

Dr. Anthony Feck, Dean of DOCS Education Faculty, writes:

Lorazepam is administered in the office the same way triazolam is—crushed up sublingually. Compared to triazolam, the onset is slightly longer; the duration of action is approximately three times longer; the amnesia slightly less; the potency is approximately one-fourth; and the efficacy is less. Lorazepam has an outstanding track record. In the DOCS Education sedation protocols the drug is well-suited for single-dose protocols that require three hours of sedation or more, sedation in 12- to 18-year-olds, and patients who take medications that have significant interactions with triazolam.

A member of DOCS Education writes:

This is my first time using lorazepam; is there anything I should keep in mind?

Dr. Anthony Feck, Dean of DOCS Education Faculty, adds:

Given your patient's weight, age and ASA status, the TOP Dose for lorazepam is 5.8 mg. TOP Dose only refers to the incremental protocol. Since you are doing a single-dose protocol, you must adhere to the maximum doses of that protocol, which would be 3 mg of lorazepam in a single dose. This maximum dose of lorazepam in a single dose would only be reserved for highly anxious patients, patients with a high degree of body fat, and patients with a known history of hyporesponse. Please refer to the doses and regimen for single-dose protocols listed in your OSD workbook.

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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 3250 Airport Way S, Suite 701 | Seattle, WA 98134. Please print a copy of this posting and include it with your question or request.
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