Sedation of Polypharmacy Patient on Multiple CNS Depressants

Can a patient on multiple CNS depressants for the same condition be treated under DOCS oral conscious sedation protocols? DOCS Education faculty weigh in.

A DOCS Education Member writes:
I have sedated about 30 patients using incremental OCS over the past year. I don't do IV (at least not yet). My question is based on my experience and this patients health: should I sedate or refer for surgery? The treatment plan is to extract 20-28 and place four implants for an implant-retained denture.

Here are the details. She is a 57 year old white female weighing 5'6" 220 lbs.

She does not have a fear of the dentist.

She is a non-smoker.

She has never had any problems with sedation for surgeries in the past.

She has controlled HTN, hypothoyroidism, controlled high cholesterol

She is on 5 different CNS depressants. The DOCS manual calls this polypharmacy.

  • Ambien® - 10mg
  • Gabapentin - 600 mg (3x/day)
  • Wellbutrin® - 150
  • Xanax® - .5
  • Celexa® - 40 (I think)

She is also taking Sythroid®, Zocor®, Hydroxhlorothizide, Prilosec®, and estradiol

According to the DOCS manual she is ASA II, but does the polypharmacy with the CNS depressants make her an ASA III?
Will this be an easy or hard sedation?

If I sedate, I will not use diazepam due to the Ambien and I will use half-doses on the triazolam since the patient is on more than three CNS depressants.

Dr. Anthony S. Feck, DOCS Education Dean of Faculty, responds:

Whether your patient is ASAII or ASAIII has much to do with whether any of her conditions limit her activity. Polypharmacology does not determine ASA status. My impression based on what you share are that she is between ASAII and ASAIII, leaning toward the II. Clues to the challenge of the sedation are the patient's BMI, and her chronic use of CNS depressants.

Your protocol for the pre-appointment doses of diazepam and triazolam are correct.

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 106 Lenora Street, Seattle, WA 98121. Please print a copy of this posting and include it with your question or request.