A DOCS Education member asks:
My 38-year-old patient presented in a state of high anxiety, among the most fearful people my office has seen. She’s a smoker with normal vitals. Her blood pressure was 93/53 and her weight 85 pounds. Her height is approximately 5 feet, and her build and frame slight. At first I suspected an eating disorder. But she recently visited a physician; blood work was done and her health appears to be good.
My instincts urge me to apply the golden protocol of incremental dosing: dose low and slow starting with 5 mg of diazepam the night before and providing 0.25 mg of triazolam in the morning. Reassess upon arrival at the office.
I expect her to be VERY sedated, but don’t want to get the BP too low, either. Do you have any thoughts or suggestions?
Dr. Anthony Feck, Dean of DOCS Education Faculty responds:
This patient is very likely to hyporespond. My most challenging sedation patients are the 85-pound females. This woman also smokes and is already highly anxious. Dose low and slow, but consider using hydroxyzine (Incremental Protocol Number 2). If she’s indeed healthy, the expected slight drop in blood pressure should not be a concern.
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.
